Challenges to Transitioning Patients from Pediatric to Adult Healthcare

Background: Transition from pediatric to adult healthcare is challenging for youth with special healthcare needs. Little research has been done to document the heterogeneity of provider perspectives on transition within a pediatric healthcare system.

Methods: An online survey designed to benchmark transition policies, processes, and obstacles, was developed and sent via email to division chiefs, all social work staff, members of a voluntary hospital-wide Transition Special Interest Group, and all advanced practice nursing staff in a large, free-standing, urban, tertiary-care, teaching children’s hospital. Division chiefs were asked to forward the survey to additional appropriate faculty and staff.

Results: There were 153 responses (22%) representing 28 divisions (93%). The most common trigger for transition was age (87.5%). Obstacles to transition ranked most important included: agreement and consensus among multiple providers on when or how to transfer care (54.2%), provider agreement whether or not to transition patients (39.9%), and provider agreement on appropriate age or time to start discussing transition (33.3%). Most respondents reported not following recommended guidelines to: send medical records to adult providers (62%), send medical summary to adult providers (57%), send plans of care to adult providers (78%), and have a formal transition policy (87%). 

Conclusions: There was little consensus among pediatric providers about the transition process despite presence of national guidelines. Few divisions followed national guidelines, including transfer of medical records and development of a medical summary prior to transfer to an adult provider.