Introduction: Transition from paediatric to adult services should usually be conducted in a staggered manner, giving the young person time to adapt to the changing environment and healthcare professionals^1. Occasionally, rapid transition in an acute setting is required and we describe here an unusual case in which this occured.

Method: A description of a challenging case that required urgent transition from paediatric to adult services in the acute clinical setting of a seriously ill child needing multivisceral transplantation.

Results: CS, a 15 year old male was admitted to a paediatric ward with life-changing diagnoses (nephrotic syndrome, recurrent pancreatitis, cholangiopathy and hypogammaglobulinaemia). Due to his age and requirement for multivisceral transplant he was cared for by multiple specialist teams across paediatric and adult services, coordinated by the paediatric WellChild nurse. Weekly MDT's were held, with discussions about his medical status, plans for transition, social care and educational needs.

It was agreed that the young person should formally transition to the adult medical and surgical teams at the point of transplant. A document including chronology of patient journey, family perspectives and fears and anxieties, was prepared for staff in ICU/HDU/ward areas. Following his transplant aged 16 years 11 months, support was provided to the patient and family from the WellChild nurse and adult transplant specialist nurses.

Conclusions: Despite occuring under urgent circumstances and entirely in hospital, this transition process was a success. This was due to the engagement and dedication of the staff involved across many aspects of paediatric and adult care. The patient and his family remained at the centre of all discussions and plans, which at times included very difficult decision making.

MDT working encouraged development of new relationships, knowledge of roles and processes within different services.

For the paediatric team it has highlighted the need for a WellChild paediatric transition nurse.

For the adult team it has given much insight into the transition process and the need for transition expertise. Particular lessons learned included how important the emotional wellbeing of the entire family is and how the inpatient environment on the adult ward had to be adapted to accomodate the family.

Overall we "Got it right" for CS and his family^1.

Reference:

1. DOH document: Transition: Getting it Right for Young People (2006)