Transition of Care - A general overview by Silja Kosolove

If adolescents are left to survive on their own without proper transition, they will not adhere to care in adult hospitals and their health outcomes will diminish, with many not surviving.

Poor health from inadequate transition leads to greater expenses, with emergency admissions and unplanned procedures being more expensive than planned care.

Patients should not be transferred during clinically unstable periods requiring frequent inpatient care, treatment regime changes, or new surgical procedures.

In many countries the age limit from pediatric to adult care has risen and is now most often 18 years, though in Finland it remains 16 years.

When 16-year-olds are transferred to adult care, adult professionals are mostly not familiar with legal requirements for child protection notifications, and the rights of the child are not properly addressed.

Cognitive skills develop logically during adolescence, but psychosocial skills take a dip during teenage years, with the timing and depth of this dip being very individual.

Illness, nutrition, and stress affect adolescent development and may lead to the developmental conflict being greatest right at the time when young people should leave pediatric care.

The last bits of the human brain to develop are in the frontal lobe, where planning for the future, problem-solving, and emotional and behavioral control are learned.

Emotional centers in the adolescent brain develop earlier than frontal lobe control centers, creating a situation where young people have strong emotions but underdeveloped impulse control.

Medical follow-up can resemble the relationship young people have with their parents, and as they struggle for autonomy they may rebel against medical care.

In many studies, quality of life has been better when judged by young people themselves than when judged by their parents or carers.

Transfer is a simple moving of paper, while transition is a prepared process with someone on the other side saying welcome and continuing the care relationship.

Patients should be met alone from the age of 12, at least for part of the appointment.

Treatment advice should be given directly to the patient even if the parent is in the room.

There is growing evidence that single days of coaching for transition have very low or no impact.

There is growing evidence that joint consultations with pediatric and adult teams both present builds trust and may lead to better outcomes.

In adult healthcare during the first couple of years after transition, consultations should be more frequent and longer than for other adult patients because trust takes time.

Young people need one named contact person between consultations, though most times they don't call, providing a sense of security.

There is strong evidence that continuity of care (management continuity, information continuity, and relationship continuity) leads to better outcomes in transition.

The process of transition cannot be on the shoulders of one single person but must be a holistic approach in the whole hospital so it continues when individuals retire or fall ill.