Objectives Paediatric critical care medicine has evolved, and 50% of admissions include children with life limiting diagnoses; a proportion of these will extend into adulthood.
Adolescents are under the management of several multi-professionals in primary, secondary and tertiary care. The transition processes for adolescents requiring critical care varies greatly throughout the UK.
We developed standards and recommendations to guide professionals in improving the experiences and care of adolescents who require management under adult critical care services.
Methods A working group was set up with representation from paediatric and adult critical care, paediatric palliative care, Hospice UK, together with patient and family representatives. This work was shared between the Intensive Care Society and the Paediatric Critical Care Society.
Our work started pre-pandemic with two face to face meetings, followed by remote meetings to consolidate the guidance produced.
Results Standards and recommendations have been published as guidance in order to support the developments of pathways for paediatric to adult critical care transition in all Hospital Trusts. We know this will vary and a more tailored approach may be more relvant.
All young persons who are likely to require future input from adult critical care services must be identified in a timely manner.
A suitable transition pathway to adult critical care services must be initiated and followed for all eligible young persons. Admission to critical care must not occur until this is complete.
A bespoke Critical Care Transition Pathway must be in place to ensure clear documentation and communication throughout the process.
The transition process for critical care should be led by children’s services.
The transition process for critical care should occur in parallel to other speciality transition needs.
There should be an Adult Critical Care Transition Lead within each Trust to co-ordinate the transition process.
A multi-professional approach should be taken throughout the process.
Where appropriate, multi-professional meetings should include the young person, families and carers.
All Adult Critical Care Units should facilitate a visit or visits for young people, their families, and carers prior to their first admission.
Where appropriate, parallel planning should be in place with the Palliative Care Team.
The transition process should include involvement of the Play Specialist Team, Family Support Workers or school.
A profile of the young person should be transferred between services and should form an essential part of their care.
Changes in the consent process should be explored and discussed with all young persons and carers. The need for any future Deprivation of Liberty Safeguards should be reviewed.
Feedback should be sought from young persons, families, carers and the Adult Critical Care team during the transition process and after transfer of care.
Conclusions The above guidance will help support the establishment of transition pathways into adult critical care. This process will be challenging as the move from parent/legal guardian consent for that of the young person/medical team holds great significance for all involved.
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