Pharmacists play an important role in patient safety, particularly bridging transitions of care between inpatient and outpatient settings. This study assessed the impact of a discharge medication education program for high-risk patients, including scheduling a post-hospital discharge telephone follow-up within 2 days of discharge. This intervention increased the number of patients who were successfully contacted post-discharge (from 20% pre-intervention to 78%) and seen in clinic within 14-days (from 49% to 60%) and reduced the 30-day readmission rate (from 19% to 10%).