Health Policy

Journal of General Internal Medicine

, Volume 24, Issue 8, pp 971-976

First online:

Transitions of Care Consensus Policy Statement American College of Physicians-Society of General Internal Medicine-Society of Hospital Medicine-American Geriatrics Society-American College of Emergency Physicians-Society of Academic Emergency Medicine

  • Vincenza SnowAffiliated withAmerican College of Physicians Email author 
  • , Dennis BeckAffiliated withBeacon Medical Services
  • , Tina BudnitzAffiliated withSociety of Hospital Medicine
  • , Doriane C. MillerAffiliated withUniversity of Chicago Medical Center
  • , Jane PotterAffiliated withUniversity of Nebraska
  • , Robert L. WearsAffiliated withUniversity of Florida
  • , Kevin B. WeissAffiliated withAmerican Board of Medical Specialties
  • , Mark V. WilliamsAffiliated withNorthwestern University

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The American College of Physicians (ACP), Society of Hospital Medicine (SHM), Society of General Internal Medicine (SGIM), American Geriatric Society (AGS), American College of Emergency Physicians (ACEP) and the Society for Academic Emergency Medicine (SAEM) developed consensus standards to address the quality gaps in the transitions between inpatient and outpatient settings. The following summarized principles were established: 1.) Accountability; 2) Communication; 3.) Timely interchange of information; 4.) Involvement of the patient and family member; 5.) Respect the hub of coordination of care; 6.) All patients and their family/caregivers should have a medical home or coordinating clinician; 7.) At every point of transitions the patient and/or their family/caregivers need to know who is responsible for their care at that point; 9.) National standards; and 10.) Standardized metrics related to these standards in order to lead to quality improvement and accountability. Based on these principles, standards describing necessary components for implementation were developed: coordinating clinicians, care plans/transition record, communication infrastructure, standard communication formats, transition responsibility, timeliness, community standards, and measurement.