High Risk Diagnosis Management Program
Case Management from Pre-Admission through 30 days Post Discharge
Daily Clinical Reviews of All Patients Placed in the Program
Expanding soon to Include COPD, THR, and TKR
Transitional Care Key Points
- The Elms of Cranbury has developed this program to promote improved communications between providers as patients with high risk diagnoses travel throughout the healthcare system.
- As the patience transitions between levels of care, the Elms Transitional Care Manager acts as the “point person” aiding hospital providers, primary care physicians and home care services, as well as patient themselves, in accessing information about the care and services they received during their stay with us.
- Or staff physicians recognize that open communication with the patient’s primary care, specialists or an emergency room physician can be an integral part in the successful management of the patient during their short term stay, and willingly collaborate to promote the best outcomes.
- The program is designed to proactively address the issues that patients and their families encounter in the management of their diagnoses, including education, medication management, access to care, and coordination of devices.
- Through direct patient post discharge up by the Transitional Care Manager, we are able to assess the patient’s management of their diagnosis once back at home and to initiate interventions as necessary to prevent hospital readmissions.
Testimonials
Contact Us
The Elms of Cranbury
61 Maplewood Avenue
Cranbury, NJ 08512
609-395-0641 
Cranbury, NJ 08512
609-395-0641