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.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Abbreviations
- BC:
-
British Columbia
- BCCH:
-
British Columbia Children’s Hospital
- CF:
-
Cystic Fibrosis
- CF-TCP:
-
Cystic Fibrosis Transition Care Pathway
- CF-TCP2:
-
Cystic Fibrosis Transition Care Pathway, version 2
- HCT:
-
Healthcare Transition
- MTS:
-
Medical Transfer Summary
- NC:
-
Nurse Clinician
- On TRAC:
-
Youth Transition Model at BCCH
- QI:
-
Quality Improvement
- RJH:
-
Royal Jubilee Hospital
- RN:
-
Nurse (Registered Nurse)
- SPH:
-
St. Paul’s Hospital
- SW:
-
Social Worker
- TCP:
-
Transition Care Pathway
- TCP2:
-
Transition Care Pathway, version 2
- VGH:
-
Victoria General Hospital
References
American Academy of Pediatrics (AAP), Committee on Children with Disabilities and Committee on Adolescence. Transition of care provided for adolescents with special health care needs. Pediatrics. 1996;98(6):1203–6.
American Academy of Pediatrics (AAP), American Academy of Family Physicians (AAFP), and American College of Physicians (ACP), Transitions Clinical Report Authoring Group (2011). Supporting the health care transition from adolescence to adulthood in the medical home. Pediatrics 128 pp. 182–200. www.aappublications.org/news. Accessed 17 Nov 2018.
Anthony SJ, Kaufman M, Drabble A, Seifert-Hansen M, Dipchand AI, Martin K. Perceptions of transitional care needs and experiences in pediatric heart transplant recipients. Am J Transplant. 2009;9:614–9.
Arnett JJ. Emerging adulthood. A theory of development from the late teens through the twenties. Am Psychol. 2000;55(4):469–80.
Baker AM, Riekert KA, Sawicki GS, Eakin MN. CF RISE: implementing a clinic-based transition program. Pediatr Allergy Immunol Pulmonol. 2015;28(4):250–4.
Betz CL. Health care transition for adolescents with special healthcare needs: where is nursing? Nurs Outlook. 2013;61:258–65.
Betz CL, Nehring WM, Lobo ML. Transition needs of parents of adolescents and emerging adults with special health care needs and disabilities. J Fam Nurs. 2015;21(3):362–412.
Betz CL, O’Kane LS, Nehring WM, Lobo ML. Systematic review: health care transition practice service models. Nurs Outlook. 2016;64:229–43.
Blum RWM, Garell D, Hodgman CH, Jorissen TW, Okinow NA, Orr DP, Slap GB. Transition from child-centered to adult health-care systems for adolescents with chronic conditions. A position paper of the Society for Adolescent Medicine. J Adolesc Health. 1993;14(7):570–6.
Busse FP, Hiermann P, Galler A, Stumvoll M, Wiessner T, Kiess W, Kapellen TM. Evaluation of patients’ opinion and metabolic control after transfer of young adults with type 1 diabetes from a pediatric diabetes clinic to adult care. Horm Res. 2007;67:132–8.
Bywater EM. Adolescents with cystic fibrosis: psychosocial adjustment. Arch Dis Child. 1981;56:538–43.
Canadian Association of Pediatric Health Centres (CAPHC), National Transitions Community of Practice. A guideline for transition from paediatric to adult healthcare for youth with special healthcare needs: a national approach; 2016. https://ken.caphc.org/xwiki/bin/download/Transitioning+from+Paediatric+to+Adult+Care/A+Guideline+for+Transition+from+Paediatric+to+Adult+Care/2017%2005%2010%20CAPHC%20Transition%20to%20Adult%20HC%20Guideline.pdf. Accessed 9 May 2018.
Cfrise.com. 2017. https://www.cfrise.com/. Accessed 13 Jan 2019.
Coyne I, Sheehan AM, Heery E, While AE. Improving transition to adult healthcare for young people with cystic fibrosis: a systematic review. J Child Health Care. 2017;21(3):312–30.
Craig SL, Phty B, Towns S, Bibby H. Moving on from paediatric to adult health care: an initial evaluation of a transition program for young people with cystic fibrosis. Int J Adolesc Med Health. 2007;19(30):333–43.
Crowley R, Wolfe I, Lock K, McKee M. Improving the transition between paediatric and adult healthcare: a systematic review. Arch Dis Child. 2011;96(6):548–53.
Cystic Fibrosis Canada. The Canadian Cystic Fibrosis Registry [online]; 2017. p. 4. https://www.cysticfibrosis.ca/uploads/Registry%20Report%202017/2017%20Registry%20Annual%20Data%20Report.pdf. Accessed 9 Jan 2019.
Dudman L, Rapley P, Wilson S. Development of a transition readiness scale for young adults with cystic fibrosis: face and content validity. Neonatal Paediatr Child Health Nurs. 2011;14(2):13.
Gabriel P, McManus M, Rogers K, White P. Outcome evidence for structured pediatric to adult health care transition interventions: a systematic review. J Pediatr. 2017;188:263–9. https://doi.org/10.1016/j.jpeds.2017.05.066.
Gleeson H, McCartney S, Lidstone V. ‘Everybody’s business’: transition and the role of adult physicians. Clin Med. 2012;12(6):561–6.
Goralski J, Nasr SZ, Uluer A. Overcoming barriers to a successful transition from pediatric to adult care. Pediatr Pulmonol. 2017;52:S52–60.
GotTransition.org. Six core elements of health care transition [online]; 2014. https://www.gottransition.org/providers/index.cfm. Accessed 29 June 2018.
Gravelle A, Davidson G, Chilvers M. Cystic fibrosis adolescent transition care in Canada: a snapshot of current practice. Paediatr Child Health. 2012;17(10):553–6.
Gravelle AM, Paone M, Davidson AGF, Chilvers MA. Evaluation of a multidimensional cystic fibrosis transition program: a quality improvement initiative. J Pediatr Nurs. 2015;30:236–43.
Hughes RG. Tools and strategies for quality improvement and patient safety. In: Hughes RG, editor. Patient safety and quality: an evidence-based handbook for nurses. Rockville (MD): Agency for Healthcare Research and Quality (US); 2008. p. 1–25.
Klostermann BK, Slap GB, Nebrig DM, Tivorsak TL, Britto MT. Earning trust and losing it: adolescents’ views on trusting physicians. J Fam Pract. 2005;54(8):679–87.
McIntosh ID. Health human resources guidelines: minimum staffing standards and role descriptions for Canadian cystic fibrosis healthcare teams. Can Respir J. 2016;2016:6369704. https://doi.org/10.1155/2016/6369704.
McLaughlin SE, Diener-West M, Indurkhya A, Rubin H, Heckmann R, Boyle MP. Improving transition from pediatric to adult cystic fibrosis care: lessons from a national survey of current practices. Pediatrics. 2008;121(5):e1160–6.
Nakhla M, Bell LE, Wafa S, Dasgupta K. Improving the transition from pediatric to adult diabetes care: the pediatric care provider’s perspective in Quebec, Canada. BMJ Open Diabet Res Care. 2017;5:e000390. https://doi.org/10.1136/bmjdrc-2017-000390.
Nasr SZ, Campbell C, Howatt W. Transition program from pediatric to adult care for cystic fibrosis patients. J Adolesc Health. 1992;13(8):682–5.
O’Loane M, Joy L. The impact of cystic fibrosis patients’ transition from pediatric to adult care. 11th international cystic fibrosis congress abstracts; 1992. Dublin, Ireland.
Paone M, Wigle M, Saewyc E. The ON TRAC model for transitional care of adolescents. Prog Transplant. 2006;16(4):291–302.
Patel MS, O’Hare K. Residency training in transition of youth with childhood-onset chronic disease. Pediatrics. 2010;126:S190. http://pediatrics.aapublications.org/content/126/Supplement_3/S190. Accessed 20 Jan 2019.
Quittner AL, Goldbeck L, Abbot J, Duff A, Lambrecht P, Sole A, Tibosch MM, Bergsten Brucefors A, Yuksel A, Castilini P, Blackwell L, Barker D. Prevalence of depression and anxiety in patients with cystic fibrosis and parent caregivers: results of the international depression epidemiological study across nine countries. Thorax. 2014;69:1090–7.
Sawyer SM, Azzopardi PS, Wickremarathne S, Patton GC. The age of adolescence. Lancet Child Adolesc Health. 2018;2(3):223–8.
Sebastian S, Jenkins H, McCartney S, Ahmad T, Arnott I, Croft N, Russel R, Lindsay JO. The requirements and barriers to successful transition of adolescents with inflammatory bowel disease: differing perceptions from a survey of adult and paediatric gastroenterologists. J Crohn’s Colitis. 2012;6(8):830–44.
Steinberg L. Commentary: a behavioral scientist looks at the science of adolescent brain development. Brain Cogn. 2010;72(1):160–4.
Suris J-C, Akre C. Key elements for, and indicators of, a successful transition: an international Delphi study. J Adolesc Health. 2015;56:612–8.
Suris J-C, Akre CMA, Rutishauser C. How adult specialists deal with the principles of a successful transition. J Adolesc Health. 2009;45:551–5.
TCPSIMPLECysticFibrosis.pdf. B.C. Children’s Hospital official website. [online]; 2016. www.bcchildrens.ca/transition-to-adult-care/Documents/TCPSIMPLECysticFibrosis.pdf. Accessed 11 Jan 2019.
Tuchman LK, Slap GB, Britto MT. Transition to adult care: experiences and expectations of adolescents with a chronic illness. Child Care Health Dev. 2008;34(5):557–63.
Tuchman LK, Schwartz LA, Sawicki GS, Britto MT. Cystic fibrosis and transition to adult medical care. Pediatrics. 2010;125(3):566–73.
Van Staa A, Sattoe JNT. Young adults’ experiences and satisfaction with the transfer of care. J Adolesc Health. 2014;55:796–803.
Whitehouse S, Paone M. Patients in transition: bridging the gap from youth to adulthood. Contemp Pediatr. 1998;13:15–6.
YouthQuizENG.pdf. B.C. Children’s Hospital official website. [online]; n.d.. www.bcchildrens.ca/transition-to-adult-care/Documents/YouthQuizENG.pdf. Accessed 11 Jan 2019.
Zhou H, Roberts P, Dhaliwal S, Della P. Transitioning adolescent and young adults with chronic disease and/or disabilities from paediatric to adult care services - an integrative review. J Clin Nurs. 2016;25(21-22):3113–30.
Acknowledgements
The author wishes to acknowledge the support of the following people: the BC Children’s Hospital Transition RN Lead (Mary Paone), CF Clinic Director (Dr. Mark Chilvers), and full CF multidisciplinary team; the St. Paul’s Hospital CF Clinic Director (Dr. Pearce Wilcox); and the CF RNs and SWs from St. Paul’s Hospital, Royal Jubilee Hospital, and Victoria General Hospital in British Columbia, Canada.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2020 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Gravelle, A.M. (2020). Bridging Pediatric and Adult Healthcare Settings in a Nurse-Led Cystic Fibrosis Transition Initiative. In: Betz, C., Coyne, I. (eds) Transition from Pediatric to Adult Healthcare Services for Adolescents and Young Adults with Long-term Conditions. Springer, Cham. https://doi.org/10.1007/978-3-030-23384-6_10
Download citation
DOI: https://doi.org/10.1007/978-3-030-23384-6_10
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-23386-0
Online ISBN: 978-3-030-23384-6
eBook Packages: MedicineMedicine (R0)