Transitional Care Clinic (TCC)
The time after leaving the hospital can be stressful and overwhelming. You may be dealing with a possible new diagnosis, medications or equipment to manage. Whatever unique situation you are in, the Transitional Care Clinic (TCC) is here to help you on your path to recovery.
Who qualifies for services at the TCC?
Before leaving Edward Hospital, inpatients who are considered high-risk or those with complicated medical conditions will be evaluated by their hospital care team to determine if they would benefit from the services provided at the Clinic.
If your care team recommends it, a scheduler will contact you before you leave the hospital to schedule your first appointment at the Clinic. Our goal is to see you within one week of your discharge date or sooner.
Who is on the TCC care team?
The Clinic care team is led by the medical director, Edward Hospital internal medicine physician and hospitalist John McAnelly, M.D., and Courtney Harley APN FNP-C, Transitional Care Provider.
Depending on your individual needs, you may see one or more of the following healthcare providers at your Clinic appointment/s:
Hospitalist (when needed)
Advanced practice nurse (APN)
Care manager/health coach
Home health clinician
How can the TCC help you as a patient?
The Clinic was developed for patients with complicated medical conditions and/or socio-economic barriers who could benefit from additional support after leaving the hospital. The program serves as a bridge after leaving the hospital to support you in your recovery until you follow up with your primary care physician. We strive to ease the transition, step by step, so you continue to get better and avoid having to be re-admitted to the hospital.
Our team of experts will:
Collaborate with your primary care doctor to plan your care after you leave the hospital
Temporarily serve as your primary care provider for up to several visits, depending on the status of your health
Review your medical conditions with you and provide close follow-up care to help keep you on the road to recovery
Provide oversight of your medications, including helping you understand what medications you are taking and why, and helping you manage any side effects or challenges of taking your medications
Connect you with any resources you need to keep your health on track, which may include access to medications or referrals to services or other specialists
Transition you back to your primary care doctor to continue your care once our role in your recovery is complete
How can you learn more about the TCC?
If you are a patient who has been recommended for the Clinic,
. learn more here
If you are a patient or family member who is interested in the services of the Clinic, ask your care team about your eligibility.
If you have any questions, you may call the Clinic at
Transitional Care Clinic location
Edward Hospital Campus
120 Spalding, Suite 305
(Valet parking available Monday – Friday, 8 a.m. – 6 p.m.)