Harold C. Simmons Comprehensive Cancer Center

Transitional Care Coordination

We understand that being treated for cancer can be difficult and confusing. This is particularly true when treatment is provided in multiple locations such as outpatient clinics, inpatient hospital rooms, a skilled nursing facility, a rehabilitation hospital, or even at home. At the Harold C. Simmons Comprehensive Cancer Center, we know that successful coordination of care requires detailed planning across these many different treatment locations.  

Moving between care settings, such as from a hospital admission to home, is referred to as “transitions in care.” Oncology transitional care coordinators are medical social workers who work with a patient’s oncology team to ensure seamless transitions in care while providing emotional support for patients and families during a stressful time. 

When to Contact a Transitional Care Coordinator

The good news is that patients don’t need to contact a transitional care coordinator. We come to patients when they are admitted to our hospital. The transitional care coordinator is part of the cancer care team and works with patients and families to make sure that all aspects of their cancer care are coordinated and seamless.

The transitional care coordinator assists patients and their families by:

  • Coordinating all their outpatient appointments after being discharged from the hospital
  • Ensuring they understand hospital discharge instructions
  • Giving them one person to contact if they need answers to questions
  • Helping them deal with the emotional aspects of care transitions
  • Helping them identify community resources that can help
  • Making sure they have the necessary medical equipment in their home

For more information, please call us at 214-645-HOPE (4673).