Background: The transition from paediatric to adult care can be challenging for patients with Type 1 diabetes. Poor contiuity of care provided by the diabetes team may worsen an already difficult time for these patients. Good transition of care is vital to minimise the risk of worsening patient outcomes. In 2016, two patients failed to transition from paediatric to adult diabetes care and subsequently received no adult appointment. This breakdown of continuity of care was a result of several failures in the patients transition of care, including the use of the Transfer of Care (TOC) document.
Objectives: We aimed to assess if recent changes to our transition pathway improves outcomes by comparing two cohorts of transitioned patients. We also aimed to review the use of the TOC document. We used our TOC flowchart, introduced following the aforementioned cases, as the standard pathway of transition of care.
Methodology: This retrospective audit compared two cohorts of Type 1 diabetic patients who transitioned between 2010 and 2013 (Cohort 1) and 20142017 (Cohort 2). We assessed glycaemic control, risk factors (retinopathy and nephropathy), attendance to diabetic appointments and admissions to hospital for diabetic pathology e.g. DKA. We compared the results preceding and following the transition date. In the most recent cohort, we also evaluated how successfully the new TOC flowchart is being documented and completed.
Results: In both cohorts, overall glycaemic control (mean HbA1c) worsened following transition to adult care. Cohort 1 saw a large reduction in attendance to diabetic appointments following transition. Cohort 1 demonstrated a large increase in admissions to hospital for DKA following transition, whereas Cohort 2 saw a decrease in admissions. The majority of catalogued TOC documents were in a format used previously; however, of those in the new format, only a minority were fully completed and clearly recorded as a TOC document.
Conclusion: Our service aims to improve outcomes through the use of an increasingly structured and documented transition process with better coordination of care with the adult diabetes team. Our data provides a baseline prior to the implementation of these processes, and is an early indication of improvement.
22 - 24 Nov 2017
British Society for Paediatric Endocrinology and Diabetes