Joint PCCS-ICS guidance for Paediatric to Adult critical care transition

In collaboration with the Paediatric Critical Care Society, the Intensive Care Society has published guidance for Paediatric to Adult Critical Care Transition.

This document aims to provide clear guidance and recommendations to manage patients transitioning from paediatric to adult intensive care. More young persons, with complex and potentially life-limiting diseases, are surviving into adulthood and may require critical care input. Many illnesses once thought to be confined to childhood, such as cystic fibrosis or metabolic disorders, now need to be managed as diseases that begin in childhood but continue into adult life.

The transition from paediatric to adult ICU requires several multi-professional and inter-professional services, including those in the hospital and community. Many of these young people, families and carers have established trusting relationships with their specialist clinical teams. It is imperative to work effectively with the families as they have an expert understanding of, and often coordinate, the young person’s care.

Lead author, Dr Clare Windsor, says: “These guidelines provide an important and positive step in the care of this group of young persons, who often have complex medical, social and psychosocial needs. It aims to improve their overall care and the experience of all involved, as they transition to the adult critical care environment. It provides a much-needed framework for establishing this necessary transition pathway”

It is also not possible to stipulate an exact age to begin the transition process, but it is important to keep the young person, their families and their carers fully informed and involved throughout the transition planning. It may only become apparent that the young person may require adult critical care services as they are nearing the age of sixteen. However, the aim should be to begin the process of transition at the age of fourteen where possible.

This subset of patients, who frequently have complex medical, nursing, and psychosocial needs, may present acutely for the first time to an adult setting where minimal information is known about them. The aim of these standards and recommendations is to improve the experiences and care of those young persons who require this input as they enter the domain of adult critical care services.

Dr Tim Wenham, Chair of the Society’s Standards and Guidelines Committee said: “These much-needed standards and guidelines are the product of extensive collaborative working and will really help all involved in a young person’s transition between paediatric and adult critical care services. I’d like to thank all the stakeholders for their valuable contributions and am delighted to see the results of their hard work finally published in such a comprehensive document”.

The standards and recommendations set out in this document will assist in the establishment of a working paediatric to adult critical care transition pathway, applicable in all Hospital Trusts. It is recognised that a “one size fits all” approach cannot be used for critical care transition and that certain aspects will be tailored to the specific working requirements of the Trusts involved.

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