Mary Washington Healthcare Transitional Care Clinic

1201 B Sam Perry Blvd., Suite 205
Fredericksburg, VA 22401
540.741.3800

The Mary Washington Transitional Care Clinic provides comprehensive, patient-centered care to optimize health and reduce hospitalizations for patients with chronic heart and lung diseases. Through this program, we work with patients and their caregivers to help them understand the disease process, recognize early warning signs and, as a result, receive effective treatment sooner.

The goal of the Transitional Care Clinic is to provide continuity of care from the inpatient to the outpatient setting. We supplement care given by primary care physicians, cardiologists and pulmonologists. We work with patients and physicians to ensure collaboration on all levels.

Comprehensive Treatment of Heart Failure and COPD

Care is available for any patient with heart failure and/or COPD, from newly diagnosed patients to those in advanced stages of the disease resulting in frequent hospitalizations. This disease management center is staffed by an experienced Nurse Practitioner, Teresa Grow, with clinical oversight by a board-certified cardiologist and pulmonologist.

Treatment plans include:

• Early follow-up after hospital discharge
• Comprehensive patient/family education to promote patient adherence and self-management
• Educational materials to assist with knowledge and adherence
• Assessment, planning, and close monitoring to recognize early deterioration and offer prompt treatment
• Optimization of medical therapy and fluid/oxygen management
• Telephone access for patients with questions during business hours

All protocols and care are based on the American College of Cardiology/American Heart Association Guidelines and GOLD (the Global Initiative for Chronic Obstructive Lung Disease).

Talk to your doctor to see if the Transitional Care Clinic can help you manage your chronic heart and/or lung disease.

Inpatients of Mary Washington and Stafford Hospital with COPD or heart failure may be scheduled to follow up with the Transitional Care Clinic upon discharge.