G46 Arrived safely? Audit of documentation of successful transfer into adult care of young people attending adolescent rheumatology clinics

Abstract

Background Concerns regarding the administrative transfer of information at the paediatric and adult interface have been raised by both patients and professionals alike. Although tracking mechanisms are recommended nationally, lapse of care at time of transfer is widely reported. This includes a previous departmental audit in 2007, which revealed potential lapse of care in 25% of transferred patients. Aims Our aim was to determine the success of transfer to adult care from a paediatric rheumatology service with a coordinated transitional care programme. Methods Retrospective case note review of all transferred patients from 2007–12 at a single UK hospital. Results Data collection revealed 152 patients were transferred to 35 adult rheumatologists with 90 patients discharged to primary care. Of patients transferred, the mean age at diagnosis was 10 years (1 –16) and mean age at transfer was 17 years (16–19). 64% (n = 97) were female and 26% (n = 39) were non-caucasian. 69% (n = 105) had Juvenile idiopathic arthritis and 59% (n = 89) were on a DMARD/biologic during transfer. 37% (n = 56) had a co-morbidity. The median (mean, range) duration between last paediatric and first adult appointment was 115 days (102, 0–457). Thirteen patients were lost to follow up, including 11 with inflammatory disease, 4 with co-morbidities, and 3 on DMARD/biologic. Successful transfer, defined by receipt of a letter from first adult appointment, occurred in 86% (n = 130) of cases, and receipt of a letter from second adult appointment occurred in 43% (n = 65) of cases. Seven were currently being transferred and not included. Referral letter, health summaries, and copy letters were sent to the adult team in 76% (n = 116) of cases, and copied to 41% (n = 63) of patients. Conclusions Although there has been an improvement in transfer organisation since the previous audit, there continues to be variation within a single paediatric rheumatology service with an established transitional care programme. Further attention to the administrative workload of transition and consistency of practice within teams is required to ensure equity and quality of transitional care within centres.