Introduction: The importance of good transition care has been highlighted by NICE and NHSI. Over the last 5 year we have focused on transforming our endocrine transition service.
Background: Our centre took part in the BSPED/BES-led 2014 National Adolescent Care and Transition Audit of Young people with Hormone Conditions. From this we identified key areas for service improvement including: families wanted to establish a better relationship with and have more confidence in staff looking after their children; wanting more information/support around transition processes and about their condition, allowing them to feel more empowered.
Methods: We worked on the following:
Named Paediatric, and Adult Consultant; named Adult Endocrine Nurse for the transition Clinic.
Engaged managers from adult/paediatric service teams; members of the Childrens Network Transition Working Group, to facilitate changes in job plans, IT processes, and implementation of the Ready Steady Go (RSG) programme.
Worked closely with a pharmaceutical company which was piloting a Structured Endocrine Transition project, providing facilitation support to align our service with the NICE guidance on transition care.
Involved parents/patients in drafting a standard operating procedure (SOP).
Follow-on service evaluation 5 years after the initial BSPED/BES audit.
Outcomes: A SOP has been agreed with critical input from families.
From January 2016 we transformed the transition clinic from a single handover appointment to a longitudinal clinic, seeing patients 23 times in a joint adult-paediatric consultation; with marked improvement in care outcomes:
All patients now complete a RSG questionnaire which is discussed during clinic; appropriate condition-specific patient information leaflets and signposting information are provided.
Patient and family satisfaction (n=21):
∘ happy with the care I receive from the transition service=95%
∘ treated well by the people who see me=90%
|May 2013-December 2015 (2.5 years): One handover clinic||January 2016June 2018 (2.5 years): Longitudinal clinic|
|Total number patients seen||41||69|
|Lost to adult follow-up||10%||3%|
|Referrals to adults seen ≤6 months||42%||81%|
Conclusions: Through extended collaborative working we transformed our endocrine transition service into a results driven, patient-centred service, with excellent outcomes.
27 - 29 Nov 2019
British Society for Paediatric Endocrinology and Diabetes