Forging an easier path through graduation: Improving the patient transition from paediatric to adult critical care

Table 3 Optimising the transition from paediatric to adult oriented acute care

Key principles	Timing	Key considerations
Patient and carer centred approach	From outset	Ensure shared understanding of health-related issues and promote concept of shared responsibilities for complex decision making: Identify possible future need for ICU; where appropriate, include patients and carers in meetings where planning will occur; coordinate transition with other relevant services, e.g., educational programs; and clear outline of expectations and possible arrangements relating to carer presence at bedside during inpatient admissions
Clear outline of responsibilities	Important throughout, but especially during transition process	Best initiated by paediatric service, and appointment of key clinical lead at adult service responsible for ongoing coordination of care
Multidisciplinary	In anticipation of transition and during process of hand-over	Well-coordinated approach by all clinical team members: Specialist medical, intensivist, nursing, allied health, and family doctor
Staged	During years of mid to late adolescence in anticipation of adulthood, consider initiating engagement with adult clinicians at 14-16 years of age	Recognise transition as a process rather than an event: Possible overlapping “shared care” approach during period of transition; orientation visits to new facilities prior to first admission; and avoid admission to adult facilities until transition is complete
Documented: Relevant past history; outline of discussions regarding treatment preferences; and suggested approach to likely clinical problems	Initially developed early during patient’s life and maintained as a useful guide for unplanned emergency presentations as well as during hand-over process at transition to adult system	Must be accessible to relevant clinicians: Secure online “living” document; up to date portable, e.g., hard copy or USB with patient/carers; can include a “patient profile” of care preferences, including tailored approach to managing issues such as communication, anxiety, respiratory support, etc.; outline of consent processes; and advanced care planning
Funding and resources	Well in anticipation of transition process	Any changes in funding or availability of resources are identified and arranged prior to commencing transition process

ICU: Intensive care unit.