Transition from paediatric surgery: how many patients do we need to plan for?

Abstract

INTRODUCTION Transitional care is an NHS priority with newly published NICE guidance. Many paediatric surgical patients need quality care to continue into adulthood. We undertook an evaluation of our departmental activity to assess the magnitude of this issue. METHODS We identified all outpatients ≥ 15 years (potentially requiring imminent transition) seen over a 12 month period for all five general paediatric surgery consultants in our tertiary centre. Those patients requiring transition were highlighted and the appropriate adult team for referral recorded. RESULTS There were 2989 general paediatric surgery clinic appointments within the year; 289 (9.7%) were for young people aged 15 years or older; 62 patients (28% of those ≥ 15years) were deemed to require transition into adult care. Significantly more patients having colorectal surgery required follow-up (P = 0.0009 Chi-square test) compared with patients in other subspecialties. CONCLUSIONS More patients than expected required transition. This may be the case in other units. Current best practice includes time intensive preclinic planning, careful preparation of patient and family, followed by joint clinics. A joint clinic appointment takes 30 minutes, allowing for comprehensive handover and forging new relationships. In our department, we need at least ten transition clinics across 2 years. Coalition with adult colleagues is vital. These data enable us to plan services to provide quality care for our adolescent patients and highlights colorectal surgery as a priority.

Clinical outcomes of non‐surgical management of detrusor leak point pressures above 40 cm water in adults with congenital neurogenic bladder

“…However, the transition of pediatric patients with congenital NGB to adult urologic care continues to pose challenges for this complex group of patients . Recently work has been undertaken to identify and promote effective transitional care of adolescent patients . Further complicating this transition is the finding that bladder physiology evolves during this time …”

“…Although as children these ACU patients could rely on their parents to help remind them to catheterize and take their anticholinergics, as adults up to 20‐25% live independently or in a group home setting . Additionally, ACU patients suffer from poor health insurance or a lack of local access to qualified specialty care . Together, these factors may combine to compromise non‐operative management of poor bladder compliance in the ACU patient and/or may lead the urologist to reflexively recommend indwelling catheter or urinary diversion.…”

Pediatric Bowel Management Options and Organizational Aspects

“…Children with colorectal diseases have unique long-term healthcare needs that extend into their adulthood [ 52 ]. Patients with a history of surgery for a colorectal disease are in a significantly higher need for transition to adult specialties compared to other pediatric surgery patients [ 53 ]. The lack of a structured transition program for patients and families negatively affects their long-term prognosis [ 54 ], leaving them without dedicated healthcare and making them seek continuous management by pediatric specialties [ 55 ].…”