Implementation of a discharge education program to improve transitions of care for patients at high risk of medication errors.

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%).