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004. Transition Needs in Adult Neurosurgery Patients

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Authors: Emma Hyde Cao

Introduction:
Adult healthcare transition is a critical component of high-quality care for children with complex medical conditions. The aim of this study is to describe the healthcare utilization of patients 19 and older in order to develop a coordinated effort to address transition needs. Particular attention is paid to neurosurgery patients.Methods: All patients 19 and older seen in our children’s hospital ED in 2019-2020 were identified. From this cohort, we identified all neurosurgical patients based on encounters with neurosurgeons. Demographic data were compared between neurosurgery and non-neurosurgery patients. Chart review on neurosurgical patients was performed to assess number of visits, admissions, surgeries, hospital stay length, provider type, visits to adult providers, and new onset adult conditions following 19th birthday.
Results:
981 patients over the age of 19 had 1565 total ED encounters. There were 56 (5.7%) neurosurgery patients with 156 (10.0%) ED encounters. Neurosurgery patient race was similar to the state population (21% black, 79% white), while non-neurosurgery patients were 59% black, 38% white (p < 0.001). Neurosurgery patients averaged 25.77 encounters, 2.67 admissions, and 2.43 surgeries after their 19th birthday. Primary diagnosis was hydrocephalus in 55%, epilepsy in 14%, and 31% other. Forty percent were most recently seen for follow-up care, 37% for feeling unwell, and 23% other. Fifty neurosurgery patients have seen 2+ providers since turning 19. Nineteen have discussed transition with their provider. Three have successfully transitioned to adult specialist care. Thirty-five patients have transition barriers related to complex medical needs. Two patients cited pregnancy concerns as their motivation to transition.
Conclusion:
Patients with complex medical conditions still have high utilization in children's ED after reaching adult age. Difficulty with finding adult providers suggests that early planning and timely transition to adult care is necessary to sufficiently meet patient needs.