VIRTUAL CARE PROGRAMS

Virtual Transition of Care

With coordinated continuous care, transitions before and after hospital care don’t have to be overwhelming.

Virtual Transitions of Care is designed to enhance the care delivered in our brick-and-mortar facilities. Our virtual multidisciplinary teams, including hospitalists, nurses, social workers and Patient Digital Ambassadors, support patients and their caregivers throughout their healthcare journey. As part of this program, we offer two types of care: 

  • Acute Boost supports patients during the vulnerable transition from hospital to home, ensuring a smooth recovery.  
  • Ambulatory Boost provides access to care for ongoing health needs like chronic disease management or connecting to a new primary care provider. Same-day primary care is also available to help patients stay on track.  

These programs enable our partners to offer their patients or employees the right care at the right time, helping to reduce hospital visits and improve their well-being. 

Visit our Partner page to learn how organizations can work with the Center for Virtual Health to offer Virtual Transitions of Care.

Acute Boost

Acute Boost offers comprehensive virtual care coordination and support for patients recently discharged from ChristianaCare and partner organizations. Our program ensures seamless transitions and continuous care through a variety of services. Patients are referred and enrolled into the program. Referrals come from the Emergency Department (ED), Hospital and Contract(s).

Key features of the Acute Boost program include:

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Discharge clinic visits:

Follow-up appointments to ensure smooth recovery post-discharge.

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Care coordination:

RN calls to manage ongoing care needs.

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Home health orders:

Review and sign orders for ChristianaCare patients without a primary care provider.

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Asynchronous communication:

Easy conversations between the care team and the patient through secure text messaging and the ChristianaCare Patient Portal.

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ED boarder assessment:

Regular assessments and huddles for emergency department boarders.

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APC support:

Providing oversight and support for advanced practice clinicians.

Additional service include: 

  • TOC Visits scheduling: Coordinating transitions of care visits.
  • Community practice coordination: Scheduling and coordinating with community practices.
  • RN referrals: Referring patients to RNs for follow-up or 30-day programs. 
  • Follow-up needs: Addressing needs identified by virtual boost providers and hospitalists.
  • External partner coordination: Collaborating with DME providers, homecare, hospice, and community practices.
  • Internal resource referrals: Connecting patients with social work, primary care, specialty care, and CCMG resources.

Ambulatory Boost

Ambulatory Boost is designed to provide centralized, virtual generalist physician support, ensuring patients receive the right care, at the right place, and at the right time. Our program aims to decrease ambulatory sensitive conditions, or health issues that lead to potentially preventable hospitalizations when not treated in a primary care setting, by providing care coordination, patient monitoring, RN triage, and virtual consultations through on-demand, same-day video visits. Additionally, this team will help expand care, creating opportunities for new patients to have timely visits with providers throughout ChristianaCare.

Key features of the Ambulatory Boost program include:

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Pre-ED, post-ED, and post-hospital follow-up:

Continuous care coordination to support patients before and after emergency department visits and hospital stays.

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Remote patient monitoring & management:

Personalized care plans tailored to individual patient needs.

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RN Triage:

RN Triage: Enhanced triage support, or assessment of needs, to ensure efficient and effective patient care.

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eVisits:

Convenient virtual consultations for primary care needs.

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Primary care clinics:

Comprehensive primary care services available virtually.

Interested in offering a Virtual Transitions of Care program?

Learn how your organization can partner with the Center for Virtual Health to offer a program that’s right for your people.