What Are Patient Management Services?

Patient Management Services at Golisano Children’s Hospital of Buffalo provides coordinated discharge planning and social work support to help children and families navigate care during hospitalization and after returning home.

Our team works closely with patients, families and healthcare providers to ensure a safe, smooth and well-supported transition from the hospital to the community. Services are available on every inpatient unit, and families are encouraged to contact the team at any time during their child’s hospital stay with questions or concerns.

Our Approach to Care Coordination

Patient Management Services focuses on individualized planning that reflects each child’s medical needs, family circumstances and community resources.

Team members collaborate with physicians, nurses, therapists and community partners to support continuity of care and reduce barriers to recovery. Families are active partners in this process and are included in discussions and decision-making throughout the hospital stay.

Discharge Planning Services

Our discharge planning team helps families prepare for the transition from hospital to home by:

  • Facilitating communication between patients, families and members of the healthcare team to develop a safe discharge plan

  • Coordinating family meetings with all members of the child’s medical team

  • Working with insurance case management programs to support discharge planning

  • Arranging medically necessary home care services and durable medical equipment

  • Coordinating home health services and specialty follow-up appointments

  • Connecting families with community-based resources when appropriate

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These services are designed to promote continuity of care and help prevent unnecessary readmissions.

Social Work Services

Licensed social workers provide emotional, practical and resource-based support to patients and families throughout hospitalization. Services include:

Counseling and emotional support during hospitalization

Assistance with financial, legal, transportation and vocational resources

Referrals to community agencies and support programs

Adoption counseling and referral services

Perinatal bereavement counseling and support

Advocacy for families navigating complex medical or social situations

Social workers help families address challenges that may affect their child’s health, recovery and long-term well-being.

Support Beyond the Hospital

Patient Management Services works to ensure families remain connected to appropriate services after discharge.

This includes coordinating follow-up care, linking families to community organizations and helping caregivers understand care plans, medications and equipment needs. Our goal is to empower families with the knowledge, tools and resources needed to care for their child confidently at home.

When to contact Patient Management Services

Families are encouraged to contact the team if they have questions about:

Discharge planning and timelines

Home care services or medical equipment

Insurance coverage or case management programs

Transportation or community resources

Emotional or family support needs

Families are encouraged to contact the team with questions about any of the following. You may reach Patient Management Services directly or ask your child’s nurse to arrange a consultation.

Contact and Location

Patient Management Services
Discharge planning and social work
Golisano Children’s Hospital of Buffalo
818 Ellicott Street
Buffalo, NY 14203

Phone: (716) 323-2210

Hours
Monday to Friday: 7:30 a.m. to 4:30 p.m.
Saturday to Sunday: 9 a.m. to 5 p.m.

Here to support your family

From the first day of your child’s stay through the transition home, our discharge planning and social work team is here to help. Contact Patient Management Services at (716) 323-2210 or ask your child’s nurse to connect you.