Transitioning together: improving patient safety at the paediatric–adult care interface

Summary

Dr Ashley Reece, Dr Lynn Sinitsky and Kelly Quinn at West Hertfordshire Teaching Hospitals NHS Trust describe how they have been working to improve how young people with complex health needs experience transition from paediatric to adult healthcare services.

They share the journey of Liam, a young boy approaching his sixteenth birthday and moving into adult healthcare services, and how the team recognised an opportunity not only to support his transition safely into adult services, but also to develop a model that could be replicated across the organisation.

They also share an accompanying video, narrated by Liam's father, that describes the family's expectations and experience of navigating transition, highlighting the challenges the family faced and the difference that coordinated planning made to the outcome.

Content

For young people with long-term and complex health conditions, the move from paediatric to adult healthcare services is one of the most significant transitions they will experience. Over the past two decades, advances in neonatal care, enteral feeding, respiratory management, cardiac and surgical interventions, infection management and chronic disease support have enabled many children with complex needs to survive and thrive into adulthood, when previously they may not have done.[1–7]

While healthcare transition is often viewed as an administrative process, it is fundamentally a patient safety issue. As increasing numbers of young people with long-term and complex health conditions survive into adulthood, the risks associated with fragmented care become more significant. Poorly coordinated transitions can result in young people being lost to follow-up, experiencing medication errors, missing essential surveillance or falling through gaps between services.

Over the past few years, our team at West Hertfordshire Teaching Hospitals NHS Trust has been working to improve how young people with complex health needs experience this transition.

Our journey has been driven by a simple principle: transitions work best when services work together around the needs of the young person, rather than expecting the young person to navigate fragmented systems and transition into them.

Starting with the patient story

Like many improvement initiatives, our work began by listening to patients and families. Young people and parents consistently described anxiety around leaving familiar paediatric teams, uncertainty about adult services and concerns about continuity of care.

As Liam approached his sixteenth birthday, the team recognised an opportunity not only to support his transition safely into adult services, but also to develop a model that could be replicated across the organisation.

Years of specialist paediatric care needed to be transferred seamlessly to adult providers without fragmenting care or losing the expertise built around Liam's needs.

The accompanying video below, narrated by Liam's father, describes the family's expectations and experience of navigating transition, highlighting the challenges they faced and the difference that coordinated planning made to the outcome.

Compiled by Dr Ashley Reece. Shared with permission.

Their story has become a powerful reminder that effective transition is about much more than transferring a medical record; it is about supporting a young person through a major life stage while maintaining safe, high-quality care. Effective transition should feel like passing the baton in a relay race: maintaining momentum, continuity and trust, rather than asking a young person and their family to return to the starting line.

Patient stories have remained central to our approach, helping us to identify risks, priorities and opportunities for improvement.

Building a collaborative approach

Liam's father described the general paediatrician as the "ringmaster" coordinating multiple services and professionals around his child's needs. This analogy resonated strongly with the team. Recognising that no single professional or organisation can deliver effective transition alone, we focused on developing a collaborative, multidisciplinary model that retained this coordination while introducing new adult teams.

Key elements of our work have included:

• Appointment of a dedicated Children and Young People's Transition Nurse Specialist.

• Establishment of stronger partnerships between paediatric and adult services.

• Development of clearer transition pathways and governance processes.

• Earlier identification of young people at risk of disengagement.

• Introduction of earlier and more structured transition planning.

• Co-production with young people and families.

• Embedding transition within quality improvement and patient safety programmes.

Throughout this work, we have seen how improved communication and shared ownership across organisational boundaries can reduce risk and improve patient experience.

Sharing learning nationally

In June 2026, we had the opportunity to share this work at NHS ConfedExpo 2026 in Manchester through our panel discussion, “Transitioning together: improving patient outcomes through collaborative transitions from paediatrics to adult services." The session attracted around 40 delegates despite taking place during the opening conference programme, generating lively discussion and engagement from attendees across a range of disciplines and organisations. A summary of the session is available on the NHS ConfedExpo website.

Delegates reflected that many of the harms highlighted within patient safety investigations, including missed follow-up, delayed recognition of deterioration and communication failures between services, can occur at transition points if robust systems are not in place.

Contributions from colleagues involved in patient safety, as well as representatives connected with the Royal College of Paediatrics and Child Health, reinforced the importance of strengthening transition pathways across the NHS.

Perhaps most encouragingly, delegates shared similar challenges from across the country, demonstrating that the issues faced by young people moving into adult services are neither isolated nor unique. This created valuable opportunities for shared learning and future collaboration, reflecting the ethos of Patient Safety Learning's hub as a platform for exchanging ideas, experiences and good practice.

Lessons learned

Several key lessons have emerged from our journey:

1. Transition is a patient safety issue. It should be recognised and managed as a period of increased risk.

2. Patient stories are powerful drivers for change. They help organisations understand the real-world impact of fragmented pathways.

3. Relationships matter. Effective collaboration between paediatric and adult teams is often the most important factor in successful transition.

4. Young people must be partners in the process. Designing services with young people rather than for them leads to better outcomes.

5. Shared learning accelerates improvement. Many organisations are facing similar challenges and can benefit from exchanging experiences and solutions.

Looking ahead

Although progress has been made, there is still much to do. As healthcare systems become increasingly complex, ensuring safe and effective transitions will require continued collaboration across organisational and professional boundaries.

Our experience has shown that when teams work together, listen to patients and families, and focus on safety throughout the transition journey, better outcomes are achievable. As more children with complex conditions survive into adulthood, transition must become recognised as a core patient safety priority rather than an optional service enhancement.

We hope that sharing our experience encourages organisations to review their own transition arrangements, learn from families and work across traditional service boundaries to reduce avoidable harm and improve outcomes for young people.

We would welcome hearing from others undertaking similar work and sharing learning about what has worked in their organisations.

References

1. Bell EF, Hintz SR., Hansen NI, et al. Mortality, in-hospital morbidity, care practices, and 2-year outcomes for extremely preterm infants in the US, 2013–2018. JAMA 2022; 327(3): 248-63. doi: 10.1001/jama.2021.23580.

2. Daniel R, Navarro F. Management of enteral tube feeds in neurologically impaired children: a mini review. Global Journal of Pediatrics & Neonatal Care 2022; 4(4). doi: 10.33552/GJPNC.2022.04.000578.

3. Jennuvat S, Khanom S, Prachasitthisak N, Vithayasai N. The outcomes and quality of life in children with neurodevelopmental disabilities with percutaneous endoscopic gastrostomy at Queen Sirikit National Institute of Child Health. Journal of the Medical Association of Thailand 2023; 106: 88-94. doi: 10.35755/jmedassocthai.2023.01.13746.

4. Balducci A, et al. Current foetal cardiology practice in Italian centres: a survey among SICP members. International Journal of Cardiology Congenital Heart Disease 2026; 24: 100659. doi: 10.1016/j.ijcchd.2026.100659.

5. Antolini G, Colizzi M. Where do neurodevelopmental disorders go? Casting the eye away from childhood towards adulthood. Healthcare 2023; 11(7): 1015. doi: 10.3390/healthcare11071015.

6. Brenner M, Kidston C, Hilliard C, et al. Children with medical complexity: an emerging population for clinical and research initiatives. Pediatrics 2011; 127(3): 529-38. doi: 10.1542/peds.2010-0910.

7. Malak R, Kaczmarek A, Fechner B, et al. The importance of follow-up visits for children at risk of developmental delay: a review. Diagnostics 2024; 14(16): 1764. doi: 10.3390/diagnostics14161764.

About the author

Dr Ashley Reece and Dr Lynn Sinitsky are Consultant Paediatricians and Kelly Quinn is a Children and Young People's Transition Nurse Specialist at West Hertfordshire Teaching Hospitals NHS Trust.