4/21/2018 1982 Transitioning Pediatric PH to Adult care 1992 Tilman Humpl, MD, PhD The Hospital for Sick Children, Toronto Critical Care Medicine and Cardiology Director, Pulmonary Hypertension Service 1993 Transition - Transfer Process - Prepare at time Transition Purposeful, planned movement of adolescents with Pre-Transition chronic conditions from child-centered to adult oriented health care system Transition Transfer Event which moves care from pediatric to adult health Transfer care environment 1
4/21/2018 Differences Pediatrics Adult Partnership with patient Focus on Growth Development Information directed Information directed towards parents/guardians to patient Problems Anxiety – caregivers and patients Different environment Different health care providers Different frequency of visits Different procedures Different treatment Transfer of medical records Incomplete Delayed Registering at new institution/timely first appointment 2
4/21/2018 Transition Workshop 3
4/21/2018 University Health Network Transition Workshop Adult Pulmonary hypertension team 11:00 – 11:15 Meet and Greet 11:15 – 11:30 Welcome - Agenda 11:30 – 11:50 Good 2 Go 11:50 – 12:10 Adult PH Program 12:10 – 12:30 Introduction of Adult team Transition Workshop 11:00 – 11:15 Meet and Greet 11:15 – 11:30 Welcome - Agenda 11:30 – 11:50 Good 2 Go 11:50 – 12:10 Adult PH Program 12:10 – 12:30 Introduction of Adult team 12:30 – 13:00 Break Out Sessions: Parents – Teens 13:00 – 13:30 Wrap Up, Tour at Toronto General Hospital 13:30 – 14:00 My Health passport, Certificate 4
4/21/2018 Transition Clinic Adult team comes to Sickkids Patient/parents Advantage History/current treatment reviewed Next appointment clearly scheduled No major changes to be expected Good bye! 5
4/21/2018 6
4/21/2018 Problem Statement Introducing the PAH Centre and Clinic Our team Our environment • There is a mismatch between the number of adult PH Centres and Meet Our Admin Assistant Hospital entrance pediatric PH Centres (many possible routes for transition creates Meet Our Doctors Check-In Desk complexity) Meet Our Nurses Our floor Floor plan of Clinic • Some adolescents are not effectively transitioned (arrive at adult The Check-In Desk About appointments centre unprepared/with inappropriate expectations) An exam room What to bring to an • Some never arrive to the first adult appointment Where echos happen… appointment • Some are lost to follow-up after the first adult appointment Where caths happen… • Some are at risk of PH and not effectively monitored Other information… “Checklist” Transfer of care - UHN Introduce PHA Canada Assess knowledge about PH – evaluate gaps Pulmonary hypertension Pulmonary hypertension with cardiac defect without cardiac defect Age appropriate education material Introduce messages about care in adult facilities Involve patient in scheduling appointments Pulmonary hypertension program Adult CHD program Explore emotional status about transition/transfer Respiratory Medicine Cardiology Consent for medical record transfer Ensure 1 st appointment is made at adult PH center Family physician Confirm that 1 st visit has happened at adult PH center 7
4/21/2018 Take home Transition/Transfer is important Continuous process – needs preparation One model does not fit all Tailor to local environment Lifestyle Understanding responsibilities Self advocacy Exercise Physical activities Medication Anxiety Nutrition End-of-life School/Career Travel 8
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