The 10 Steps Transition Pathway: Improving Transition for Children in Hospital Settings Jacqui Rogers, Lynda Brooks, Lizzi Aizelwood, Axel Kaehne Abstract Background: Health transition from children‟s to adult services has been recognised as an important aspect of quality and service improvement for many years. However, transition for young people remains a disruptive experience for everyone involved. Alder Hey Children‟s NHS Foundation Trust is one of the busiest children‟s hospitals in Europe and its transition arrangement had been identified as an area for improvement within a previous CQC report. Aims and Objectives: The paper outlines a project to develop a 10 step transition pathway for a complex cohort of young people that was produced as part of a care quality improvement programme at Alder Hey. Methods: We used a mixed method approach to capture views and opinions of members of staff at engagement events and utilised a survey instrument to collect perceptions of key professionals on the barriers and facilitators of good transition. The analysis of data was then used to develop a ten step transition pathway and protocol. Findings: The transition improvement programme and development of the transition pathway brought about an increased understanding about the barriers and challenges of transition work. It demonstrated what is and isn‟t working well, where policies conflict or practice inconsistencies exist across the trust between different specialties. Conclusions and Implications for Practice: The project showed the clear need of a key worker or lead consultant for each individual. The pathway identifies a 10 step protocol which lists key steps to be taken by those key workers to ensure a successful transition. The protocol developed was seen as a useful resource to plan transition pathways for children with complex care needs. Full Text: PDF DOI: 10.15640/ijn.v5n2a1
Objectives To explore paediatric subspecialities' roles and their perceptions of the need for palliative care among children with long term neurological conditions (LTNC) compared with paediatric palliative care specialists. To examine the ease of access to healthcare services among children with LTNC. Design Electronic questionnaire survey of members of BPNA, BPPM, BACD, and BACCH. 24 questions evaluated different aspects of practices and attitudes of palliative care among children with LTNC by linear analog scale and multiple choice responses. Results Total of 130 respondents from different specialities completed the questionnaire: 38 (29%) paediatric neurology, 18 (14%) general paediatrics, 26 (20%) community paediatrics, 24 (18%) paediatric neuro-disability, 18 (14%) paediatric palliative care and 6 (5%) other specialities. Majority respondents, 111 (85.4%) often look after and provide end of life care to children with LTNC and 118(91%) believe palliative care would be appropriate. Most non-palliative care respondents would refer children with life-shortening (104/112, 92.9%), progressive (110/112, 98.2%) or stable (90/112, 80.4%) neurological conditions to palliative care. However, most non-palliative care respondents (74/112, 66%, p=0.013) would not refer children with life-threatening conditions to palliative care. There is notable overlap in the palliative care related activities of each subspecialty. Both palliative care and non-palliative care respondents recognised core elements of palliative care specialists to include symptom management, psychosocial and spiritual support, and management of death and bereavement support. Many respondents reported difficult or no access to specialist palliative care (62/130, 47.7%) and specific services such as clinical psychologists (84/130, 64.6%) and social services (42/130, 32.3%). Conclusions This survey highlighted the appropriateness of palliative care among children with LTNC, and revealed a gap between established palliative care guidelines and perceptions of many paediatricians. Paediatricians should recognise that every life-shortening or life-threatened child should have access to palliative care and support. To avoid duplicating care provision and competing for limited resources, there is a need for close co-ordination of services.
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