Bridging Pediatric and Adult Healthcare Settings in a Nurse-Led Cystic Fibrosis Transition Initiative

Abstract

The focus of healthcare transition (HCT) for adolescents and young adults with long-term conditions has centered mainly on the pediatric setting; however, it is likely the HCT process ends much later than originally thought. This chapter outlines two nurse-led cystic fibrosis (CF) quality improvement initiatives. The first is a retrospective chart audit to determine if best practices were implemented during the transfer from a pediatric to adult CF clinic, including a measurement of initial adult setting integration. Findings demonstrated that most CF patients were transferred in their 18th year; there was an excellent completion and handover rate of Medical Transfer Summaries; and almost all patients completed a first adult provider appointment. There was a slightly longer than recommended time gap between the final pediatric and first adult provider appointments, and 81% of patients attended at least three adult provider visits in the first year post-transfer. Today there are comprehensive practice guidelines for the transfer period, accessible online. The second project aimed to adapt and implement a transition clinical pathway (TCP) in four pediatric and adult CF clinics in one Canadian province. The TCP was successfully adapted to be CF-specific but after 1 year, only one of the four clinics (which had decades of experience with HCT) was utilizing the TCP due to a lack of professional time and education. Institutional support for the implementation of pediatric and adult-based transition practices is imperative.