Table 1.

Elements of an intervention, and example activities, that can influence the safety and quality of transitions between care settings 1

Influential element	Description	Examples of activities to improve this element
Information	The quality of information that is exchanged between care settings in terms of completeness, accuracy and clarity.	Medication reconciliation by a hospital pharmacist, study pharmacist, liaison pharmacist or community pharmacist; electronic templates as the main method of information sharing; database-generated discharge summaries comprising structured formats to organize information; clinical decision support, alerts for pending results and online reference information.
Coordination of care	The quality of assessment, planning, and organization of follow-up services and needs.	Organizing post-discharge services or follow-up; a discharge planning protocol; early assessment of follow-up needs and resources; general practitioner input into discharge planning; post-discharge check for follow-up needs, adjustments and arrangements.
Communication	The quality of exchanging information in terms of personal and direct contact, accessibility, and timeliness.	The use of a liaison pharmacist or nurse; use of a fax or e-mail to transmit discharge summaries, plans and other relevant information in a timely manner; electronic notifications to inform GPs about patient hospital visits and available discharge information; telephone outreach from hospital to home care to notify the primary contact for follow-up consultation; face-to-face meetings in community or hospital; case conferences by telephone.