Objectives Moving from paediatric to adult services is a worrying and challenging time for young people with long-term conditions such as epilepsy. Evidence suggests that effective transition between services can improve long-term outcomes (1), yet national data highlights that transition is often overlooked with little recognition as an area of importance within healthcare (2). However, there has recently been a drive to refine and improve the transition process through the NHS long term plan.
This quality improvement project aimed to achieve the NICE quality transition standards (3) of care for epilepsy across a nine-month period in one paediatric department.
Methods An initial gap analysis was undertaken using 11 NICE quality transition-focused standards of care to demonstrate current performance of services for epilepsy. Diagnostic tools including a process map, fishbone diagram, and RAG rating were completed to help define the problem further. Some of the factors included lack of engagement from adult services, increased workload for the paediatric team and lack of dedicated transition clinics. Following this, several change ideas were generated and PDSA cycles were undertaken. Some of the change ideas included regular transition progress meetings, along with implementation of time-bound action points, using the Ready, Steady, Go paperwork and setting-up joint transition clinics between paediatric and adult services.
Results Baseline measurement following the initial gap analysis showed that only 27% of transition-related standards of care were met for epilepsy. Following the implementation of several change ideas, the measurement for partially meeting and meeting standards increased collectively to 73%.
Conclusions This QI project has enabled one paediatric department to better achieve NICE transition standards of care for young people with epilepsy. Certain highlights and achievements included setting-up joint transition clinics between paediatric & adult services, which created engagement at a Trust level along with recruitment of a new epilepsy transition nurse specialist, through Roald Dahl’s Marvellous Children’s Charity. Measurable progress has been made in implementing transition-related standards of care, however; further work is needed to ensure young people and their families are actively involved in the design, delivery, and evaluation of transition services.
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