Background: Children with medical complexity experience repeated hospitalizations into young adulthood. At the University of Wisconsin, approximately 3 patients per week between ages 18-21 years are hospitalized at the children’s hospital, with over half of these patients having more than 3 chronic conditions as defined by the Agency for Healthcare Research and Quality. These patients are poised, ready or not, to transition to inpatient care to the adult hospital in the near future. Although there has recently been considerable interest in improving outpatient transitions for medically complex youth, little or no attention has been paid to the transition of care from a children’s hospital to an adult hospital. Nonetheless, this is a particularly vulnerable time for such patients and the adult hospitalists caring for them.
Purpose: To improve the transition between inpatient pediatric to internal medicine (IM) care for medically complex young adults at a tertiary care academic medical center. We hypothesize that a proactive, well-defined, multi-element process will improve the patient experience and allow hospitalists to better care for these patients.
Description: We assembled a multidisciplinary team of pediatric and IM hospital medicine providers, including patients and families. With input from this group, we developed current- and ideal-state process maps to illustrate this transition. Seven transition domains were identified with 31 discrete processes, and 20 discretely measurable elements. Using multi-vote methods, 3 top intervention priorities were established: 1) developing a multidisciplinary transition care plan; 2) creating electronic health record (EHR) technology to document transition activities; and 3) addressing anticipated insurance challenges. Focusing on the top priority, a comprehensive transition assessment and planning tool was developed and refined through pilot testing. After 5 Plan-Do-Study-Act cycles, the tool was able to be completed in less than 30 minutes, administered by nursing staff, with positive qualitative feedback.
Conclusions: Inpatient youth-adult transition planning can be achieved efficiently with the use of a comprehensive assessment tool. This information provides high-yield and patient-centered information essential to successful transition from pediatric to adult inpatient care. Our next steps will incorporate the tool into the EHR and measure patient, family and provider satisfaction with this transition process. Long-term, our team will study hospital utilization outcomes surrounding the first adult hospital stay as the new inpatient transition process is implemented.