Happy New Year!
“Adults are just obsolete children” –Theodor Seuss Geisel
So, begins an interesting commentary (B Kinnear. JAMA pediatrics 2015; 169: 1081-2 -thanks to Ben Gold for this reference).
This editorial discusses a growing problem of patients older than 21 years of age seeking care in pediatric institutions. Currently, ~15,000 admissions occur annually in the U.S.. At the author’s institution (Cincinnati Children’s), the average daily hospital census was 15.7 patients between 2012-2014. In fact, at Cincinnati, which has an adult care hospital across the street, they have developed a team to care for these patients: “the Hospital Medicine Adult Care team.” In addition, they have established protocols to recognize and initiate treatment on problems like acute coronary syndrome, pulmonary embolism, and acute stroke.
The author argues that age should not be the only factor determining which institution would offer the best care. Some cognitively impaired adults with cerebral palsy may be better-suited at a pediatric facility and some obese teenagers with type 2 diabetes and hypertension may fit better at an adult care hospital.
Common barriers to transitioning to adult care hospitals:
- Lack of adult health care professional knowledge and comfort by adult health care physicians
- Poor communication between pediatric and adult care providers
- Families fear of leaving established care settings
These adults in pediatric care settings do have increased length of stays and greater odds of mortality than adolescents, even when adjusting for the increased number of chronic conditions. Thus, it is not entirely clear that outcomes will be improved by retaining this vulnerable population at pediatric institutions. Much of this question will be determined by the institutional resources available for their care.
My take: I worry that keeping adults (patients >21 years) in pediatric institutions is a mistake. There are increasing numbers of vulnerable patients and their needs should be addressed by adult care providers.