924 TRANSITIONING CARE OF COMPLEX PAEDIATRIC UROLOGICAL TO ADULT SERVICES

Abstract

You have accessJournal of UrologyPediatrics: Reconstructive Surgery1 Apr 2010924 TRANSITIONING CARE OF COMPLEX PAEDIATRIC UROLOGICAL TO ADULT SERVICES Dan Wood, Brid Carr, Kim Robinson, and Christopher Woodhouse Dan WoodDan Wood More articles by this author , Brid CarrBrid Carr More articles by this author , Kim RobinsonKim Robinson More articles by this author , and Christopher WoodhouseChristopher Woodhouse More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.2431AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The move of a complex urological patient from a paediatric health care environment to adult healthcare may result in a number of difficulties. They may form strong attachments to their paediatric team, having had multiple operations. A few have complex issues that have been confided in the team they know well but disclosure is unlikely to follow in the adult environment for some time. This paper examines the benefit of a dedicated, multi-disciplinary, transition clinic in order to improve this experience for both patient and treating physicians. METHODS Patients from the age of 12 years old are considered on an individual basis for transition to adolescent and adult services. Those who have clinical difficulties or complex issues are initially seen and assessed by an adolescent urologist in a joint appointment with the patient's paediatric team. These run in a monthly transition clinic. These are prolonged appointments allowing detailed discussion. There is a review of current clinical notes and generation of a transition summary. Ongoing treatment or investigative plans are made and the next review is set for the adolescent clinic in the new institution. RESULTS Thus far 15 patients have been identified and seen in our transition clinic. 5 with bladder exstrophy, 2 with cloacal exstrophy, 1 with posterior urethral valves, 3 neuropathic disorders, 2 complex developmental anomalies and one with severe voiding dysfunction. 4 had previously failed to transition to adult services, 1 had been lost to follow up. 3 had issues about sexual function – disclosed only on the basis of prompting by their paediatric specialist nurses. The majority wanted to discuss issues about long term management and to formulate or understand how this might work. Each patient has a transition summary generated by their paediatric team, as well as a summary of the consultation in a letter. They are then seen in an adult clinic to follow up on this consultation. Patients benefit by comprehensive information sharing from both themselves and healthcare teams allowing, rapid identification and management of any surgical or other issues. This reduces risk of patients becoming lost to follow up it also provides a definite point of contact for patients in transition. CONCLUSIONS This service has lead to increased joint working between paediatric and adult services and provides a multidisciplinary environment for transition of patients from one to another. We advocate the transition of adolescent patients through a specific service as a means of improving both patient experience and long term clinical care. London, United Kingdom© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e360 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Dan Wood More articles by this author Brid Carr More articles by this author Kim Robinson More articles by this author Christopher Woodhouse More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...