67 Transition to adult care audit cycle: impact of a central transition team

Background Transitional healthcare is increasingly recognised as a priority for young people with chronic medical conditions. NICE quality standards for Transition were developed in 2016 to enable services to identify areas for improvement.1 We performed a trust-wide audit examining compliance with the NICE quality standards in 2017, implemented new measures, and repeated the audit in 2019. The new measures were led by a central transition team and included a transition section in electronic notes, electronic ‘live’ transition plan, learning from complaints and incidents, identifying transition champions, addressing organisation-wide barriers to transition, developing clear pathways for accessing support for patients with complex transitional needs, and obtaining feedback on transitional experience. Objectives Objectives were To assess compliance with NICE Transition Quality Standards To assess whether measures implemented after the 2017 audit resulted in a change to compliance with NICE Transition Quality Standards To review subgroups of patients, including complex patients requiring transition under three or more specialties, to assess whether more input is required in these particular patient groups. Methods We reviewed two weeks of inpatient data (30th Sept - 13th Oct 2019) to identify patients with long-term medical conditions requiring transition, and assessed their transitional care against the NICE quality standards. The methodology was identical in 2017 and 2019. Did discussions around transition begin by age 14 (or at diagnosis, if later)? Was there an annual meeting where transition was discussed? Was there evidence of a named transition worker? Did they meet a practitioner from adult services before transferring? [partially assessed as most patients had not yet had their care transferred] Results We identified 43 transition episodes in 2017 and 90 in 2019. Overall, transitional discussions had started in 70% of patients, an improvement from 2017 (58%). Most patients still had not started transition planning early (36% 2017, 24% 2019) but more had an annual review (44% 2017, 73% 2019) and a named worker (20% 2017, 48% 2019). We identified three patients who had transferred to adult care without meeting an adult care provider. The transitional care of complex patients (under 3+ specialties) had significantly improved across all criteria between the two audits with 100% having started transition vs 66% in 2017. Conclusions The 2019 audit demonstrated improvement overall, but identified areas requiring ongoing development particularly with early transitional planning. Next steps include age-based transition prompts in electronic notes, embedding links to transitional information in clinic letters, and arranging virtual visits to adult services. References National Institute for Health and Care Excellence. (2016). Transition from children’s to adults’ services for young people using health or social care services (NICE Guideline NG43)