P. Oster et al., THE GERIATRIC TEAM IN PREDISCHARGE AND PO STDISCHARGE NURSING AND THERAPEUTIC CARE, Zeitschrift fur Gerontologie und Geriatrie, 28(2), 1995, pp. 118-121
The transition team has its place in pre- and postdischarge nursing an
d therapeutic care, on the basis of a geriatric assessment. Core membe
rs of the team are, in the sequence of the scheduled performance in-ho
spital, nurse, occupational therapist, physiotherapist and social work
er, supplemented by a team physician. Two-thirds of all treatments wer
e in the hospital, one-third in an outpatient setting up to 4 weeks af
ter discharge. Cooperation with outpatient services has been good.