Seamless transformation of our transition and young adult service

Published Date: 01st April 2024

Publication Authors: Balafshan. T, Sullivan. H, Keigan. S, Wilson. A, Gallagher. C, Ahmad. I, Brennan. A, Jones. L, Updarasta. S

Conference Abstract

Introduction: Following RCPCH peer review of our Paediatric Diabetes Service in 2021, concerns were identified regarding the transition and transfer policy at (formerly known as) St Helens & Knowsley NHS Trust for young people with diabetes from ages 16 to 18 years from paediatrics to adult services. Prior to the review our transition service consisted of two handover clinics per year.
Aim(s): Through involvement with the Seamless Transition Quality Initiative Programme, the paediatric and adult diabetes teams combined forces to develop a transition MDT.
Method(s): We completed the 9-month Seamless diabetes transition programme, including four phases with learning events and coaching calls. Providing the tools to implement changes to make positive change to our service and patient experience. We started by updating of the transition policy and SOP through combined working. Following this, 12 transition MDT clinics were established, comprising of adult and paediatric doctors and diabetes specialist nurses, dietitians and psychologists. The clinic is designed for patients between the age of 16 and 18 years, to review each young person four times prior to transfer to young adult services. We have initiated service evaluation projects to gather information about patient engagement, service design, education, integrated care and teamwork for ongoing development.
Conclusion(s): The past year the number of clinics has increased to 15, gained an additional adult diabetes doctor, adjusted the format of the clinics and started using 'Ready, Steady, Go- and 'DigiBete' with great outcomes. These changes are thanks to the skills we gained with the Seamless diabetes transition program.

Balafshan T.; Sullivan H.; Aung E.; Keigan S.; Wilson A.; Gallagher C.; Ahmad I.; Brennan A.; Jones L.; Updarasta S. (2024). Seamless transformation of our transition and young adult service. Diabetic Medicine. 41(Supp. 1) [Online]. Available at: https://dx.doi.org/10.1111/dme.15296 [Accessed 19 December 2025].