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A review of transition arrangements from paediatric to adult services
  1. S N S Lau1,
  2. A W Kelsall2
  1. 1School of Clinical Medicine, University of Cambridge, Cambridge, UK
  2. 2Department of Paediatrics, Addenbrooke's NHS Trust, Cambridge, UK

Abstract

Aims Adolescents with chronic health problems are poorly provided for in the UK.1 National standards have been developed for the transition of paediatric patients to adult services.2 We reviewed practice in paediatric cardiology both locally and across the region and for other specialties in this institution.

Methods A retrospective study of patients attending cardiac clinics was conducted. Electronic letters were reviewed for children over 13.5 years. An email questionnaire was sent to the specialty clinical leads. Regional paediatric cardiology was surveyed in the safe and sustainable review. We were interested in the age when transition commenced, whether or not joint clinics with adult specialists and liaison nurses were conducted, number of transition clinics per year, age of transfer and age of the oldest patient in clinic.

Results In Cardiology, over 5 years (1 April 2004–20 August 2010), 136 patients were transitioned, with 81 eligible for transition over the next 2 years. Mean age at transition was 16.3 (12.0–19.9) years. Following the development of a dedicated grown-up service in Papworth in 2009, 44 (76%) patients have been transferred there, with 23 (52%) attending the joint multi-professional transition clinic. Across the region, no other joint cardiac clinics exist and the process is ad hoc in 7 out of 17 responding units. In this institution, responses were received from seven specialties (Oncology, Haematology, Neurology, Cardiology, Hepatology, Rheumatology, Urology). Five have agreed transition policies and conduct joint transition clinics with adult specialists, 4/5 have input from specialist nurses. The format of transition varies, Haematology, Oncology, Rheumatology and Urology have ad hoc clinics. Hepatology has 1 clinic. Cardiology is increasing from two to four clinics. Neurology has four clinics per year. The number of transition clinics attended by patients varies from one to more than four (Neurology). Transition age ranges between 13–16 years. The oldest patient seen was 18 years.

Conclusions This study demonstrates that local transition arrangements are well established across a number of specialties in line with national recommendations. The process is tailored to the needs of each specialty, a universal agreed policy of transition for patients in the institution is recommended to guide practice.

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