Abstract
The department of medical social work and discharge planning was established in the University of Tokyo hospital to ensure that patients would receive proper care at right place. The discharge planning team consists of a physician, a medical social worker and a home care coordinator.
The home care coordinator, who coordinates with the home nursing station and the primary care physician, is effective for advance of home care. The role of the home care coordinator is to relieve patients of their anxiety about home care. As a result, the number of home care patients has gradually increased.
