When does care coordination begin and end?

• A. Prior to admission for elective procedure to 30-90 days after discharge.
• B. Only during admission.
• C. Only after discharge.
• D. The end date is one year after discharge.

Answer: (A)

Care coordination is a continuous process that starts before a patient even enters for an elective procedure and continues after discharge. Beginning pre-admission allows the team to identify risks, reconcile medications, arrange needed services, and build a plan with the patient and family. Carrying that plan forward through the hospital stay and into the post-discharge period ensures a smooth transition, including arranging follow-up appointments, home or community supports, and ongoing monitoring. The post-discharge window of about 30 to 90 days is a key period for addressing barriers, confirming understanding of discharge instructions, and preventing gaps that could lead to readmission. Ending the coordination after 30–90 days aligns with that transition-focused support.

Limiting care coordination to the admission misses crucial planning and handoffs, while ending far beyond this window (like a year after discharge) isn’t the standard practice for typical transition care.