Young adults in children's hospitals: why are they there?

Objective: To measure the pattern of admissions of young adults to a children's hospital. Design and setting: Ten-year audit (1992-2001) of admissions of young adults aged 18 years and over to the Royal Children's Hospital (RCH), Melbourne, with a detailed chart review of the 2001 cohort to assess disease complexity and transition planning. Outcome measures: Number of admissions, disease complexity, transition planning. Results: There was a significant increase in the number of young adults admitted over 10 years, from 308 in 1992-1993 to 659 in 2000-2001. The greatest increase was in admissions to surgical units. There was significant variation in admission practices between units over time. Many young adults required multidisciplinary care: 57% had more than three medical/surgical units involved in their care, and 34% had two or more allied health units involved. Fifty-one per cent of surgical inpatients and 28% of medical inpatients had no documented plan for transition to adult care. Only 30% of medical and 17% of surgical inpatients in 2001 had been transferred to adult services by 2002. Conclusions: Both disease complexity and failure of transition planning appear to have contributed to the increased admission of young adults to the RCH. While greater support of transition planning is needed, there are also concerns about the lack of appropriate services within the adult sector for young adults with complex, multidisciplinary healthcare needs.