MON-864 - Bridging the Gap: A Quality Improvement Initiative Improving Transitions of Care from Pediatric to Adult Endocrinology at A Tertiary Safety Net Academic Center

Background and

Aim: The transition from pediatric to adult care is a vulnerable time for adolescents with chronic endocrine conditions, often overlapping with significant developmental, social, and healthcare system changes. Without a structured process, this transition can result in loss to follow-up, resulting in poor disease management and increased complications. Research shows that structured transition programs help reduce these risks and support better long-term outcomes. We aimed to increase the number of adolescents with chronic endocrine conditions referred by pediatric endocrinology who successfully completed an initial transition visit with adult endocrinology from 50% to 60% by Q3 of 2025.

Methods: We conducted a quality improvement initiative using the model for improvement. To identify improvement opportunities, we analyzed patients who failed to transition in 2023. 75% of transitions failed due to patients being unreachable or appointments being unavailable, highlighting that scheduling appointments was the biggest driver of transition failure. We implemented several interventions focused on standardizing pediatric referral workflow and scheduling patients. These interventions included creating an Epic transition summary smart phrase with drop down menus, an after visit summary smart phrase, and a transition care user guide for pediatrics providers; consolidating the referral workflow for patients with and without T1D; identifying specific transition scheduling staff; automatically scheduling transition visits for unreachable patients; and using multimodal communication strategies with standardized smart phrases to contact patients with these automated scheduled appointments. We measured implementation of these interventions as process measures: referral number, transition summary use, and scheduling success rate. Our outcome measure was the % of referred patients who completed an initial transition visit.

Results: The number of transition referrals increased from a median of 6 to 16 patients per quarter. Transition summary use increased from a median of 0 to 8 per quarter. Referred patients with scheduled appointments increased from a median of 69% to 81%, achieving 100% in Q3 of 2025. 71% of unreachable patients scheduled for an automated appointment showed to their initial appointment. The number of referred patients who completed an initial transition visit increased from 4 to 10 per quarter, going from a median of 50% to 73%. In Q3 of 2025, 100% of referred patients completed their transition visit. Our balancing measure demonstrated a stable no show rate throughout.

Conclusion: Using QI methodologies, we were able to improve successful pediatric to adult endocrinology transitions at our tertiary safety net academic center. Scheduling was a key component of the success of this work, and scheduling staff support was instrumental.

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