Research shows that 20 percent of patients in the U.S. are rehospitalized within 30 days of discharge. Although some patients are readmitted for medical reasons, many of the patients are readmitted for social or resource issues and not for medical issues. Effective strategies to reduce readmissions must incorporate both social and medical factors in order to be successful. Poorly executed transitions in care negatively affect the patient’s health and well-being, family resources, and unnecessarily increase the costs incurred by the health care system. WSHA is working with all the health care agencies involved in the continuum of patient care from hospital to home to ensure that patients do not end up back in the hospital.