Background A major theme in this project was seeing if clinicians at UCLH were providing developmentally appropriate healthcare (DAH). This is about making healthcare work for young people (YP) by recognising their changing developmental needs and the role of healthcare in addressing these. Engaging with YP in clinical practice, communication, confidentiality and seeing them alone are all key elements. The Department of Health’s ‘You’re Welcome’ quality criteria encourages clinicians to provide DAH to YP, ensuring the care they provide follows several criteria. One of the criteria relates to confidentiality and consent, which is explored in this project. Providing good written communication is also an important element of DAH. Written communication is provided through clinic letters, which are written following every consultation between a patient and their healthcare professional (HCP). The letters provide fundamental and effective collaboration and record keeping between the patient and HCP. The Academy of Medical Royal Colleges have recommended that clinic letters should change from being written to the young person’s GP to writing directly to YP. However, it is unclear whether clinicians at hospitals are implementing this guidance and other advice from the ‘You’re Welcome’ quality criteria.
Aims Firstly, to determine the proportion of clinic letters that are being directly addressed to YP, and who they are copied to. Also, to assess whether adolescents were offered time alone during the appointment. Finally, to judge whether these letters demonstrate collaboration between the YP and their doctors and if the letters written are well structured.
Methods A clinical audit was performed within a hospital setting to evaluate whether clinicians were addressing letters directly to YP aged 16–19 years and if they demonstrated DAH. 367 random clinic letters written from the breadth of paediatric and adult teams who see young people were evaluated.
Results Overall, 19.6% clinic letters were addressed to YP directly. Positively, 85.6% of these letters had a good structure and 70.8% of them demonstrated collaboration. Although, 1.6% of the letters highlighted YP were offered time alone, however it was decided this most likely does not reflect accurately on what is truly happening because this information was difficult to collect from reading clinic letters alone. Therefore, this element will be investigated through an alternative method in the future. Additionally, 45.8% of the letters written directly to adolescents had neither their GP/HCP copied in, which was a concerning find because copying the GP/HCP into the letter ensures a record is kept and allows for continuity of care.
Conclusions The results showed that the Paediatric and Adolescent division performed the best in writing to YP directly, compared to other specialities, as 33.3% of their letters accomplished this. However, this is still minimal, and training is needed to help clinicians ensure they are following the guidance to provide DAH to YP. Writing to YP directly and following the ‘You’re Welcome’ quality criteria helps build a better doctor patient relationship, allowing them to trust in the healthcare system and encourages them to take ownership of their health which should lead to better health outcomes.
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