Read the Transitional Care Programme Lit Review provided. Related --- # Takeaway for me 1. Some papers say there is efficiency, while others say there is none. 2. There is an increased risk of suicide and self-harm after discharge, but I am not sure why that is. 3. I wonder if it's due to a lack of connections after discharge; no rapport to link that patient back? 4. What are the reasons for poor adherence and increased risk? 5. One useful suggestion to ensure Continuity of Care in 1997 Meiseler Et Al [7] 1. Inpatient staff's responsibility to interface between inpatient and outpatient care 2. period between discharge and outpatient care should be short 3. The case manager must have the option to visit the patients at home 4. patient need more intensive care in this period after discharge. 6. Recommend an individualised care plan and discharge planning - what should be included in this? what how to do it? and why is this important?