Caring for young adults on a paediatric ward

Abstract

The need for adolescents and young adults (AYA) to have suitable age-specific inpatient facilities has been recognised for many years, yet has received relatively little attention. This article reports the successful introduction of an inpatient facility for AYA, aged 17-24 years, on a general paediatric ward in a small district general hospital. From December 2010, a young person's unit (YPU) consisting of an 8-bed area was opened within a 24-bed children's ward. Nursing care was provided by the ward staff, all of whom had been trained in the care of young adults. Policies regarding admission criteria, safeguarding, patient choice, visiting and 'house rules' were drafted, implemented and modified as necessary. Discussions with the adult clinicians (for medical care) and site managers were held to ensure smooth running of the system, and to address any concerns or difficulties. Paediatric patients had priority of admission at times of bed crisis. During 2012, there were a total of 2351 inpatient admissions to the paediatric ward, of whom 379 (16%) were YPU patients aged from 17-24 years. Median length of stay was 2 days for patients aged 17-24 years as compared with 1 day for patients aged less than or equal to 16 years. Patients who chose admission to the paediatric ward tended to be younger, in transition from paediatric to adult services for chronic conditions, or with special needs. Patient surveys showed a high level of satisfaction with the facility. Young adults can be cared for safely and effectively on a paediatric ward with minimal additional costs. The essential ingredients for success include discussion with affected parties to address specific concerns, and the establishment of a clear, simple and unambiguous admission policy.

Transitioning adolescent and young adults with chronic disease and/or disabilities from paediatric to adult care services – an integrative review

“…() found patients aged 16–17 years with chronic medical conditions remained predominantly under the care of paediatricians (70% of their visits); while patients aged 17–24 were continuing to be seen by a paediatrician for 16% to 36% of their visits (Heaton et al . , Stewart et al . ).…”

Perspectives from the periphery of Paediatrics

“…Furthermore, a study in the BMJ found that over a third of young adults lost their successful kidney transplant when transitioning from paediatric to adult care (Harden et al, 2012 ). Additionally, a 2012 study found that patients aged between 17 and 24 had greater median hospital stays compared to those aged 16 and below at 2 days and 1 day, respectively (Heaton et al, 2013 ). Although small, this gap should be non-existent as every extra second, minute and hour spent in hospital environments place additional anxiety on patients, parents and carers (Australian Psychological Society, 2016 ).…”

“…A study investigating this issue regarding adolescents with Type 1 Diabetes found that patients were greatly disillusioned with discrepancies in follow-up experiences, with particular disappointment in adult care (Iversen et al, 2019 ). Furthermore, young people cared for in paediatric wards had greater satisfaction rates than those in adult wards at 54% and 44%, respectively, outlining once again the lack of communication and support regarding changes in care (Heaton et al, 2013 ). It mustn't be overlooked that, with this shift, a huge responsibility is now placed on the young person; adults, in most cases, must make their own healthcare decisions and a sudden shift to this environment with such expectations can initially be daunting.…”