adult patients admitted to a pediatric hospital

umcRN, BSN, RN · May 12, 2012

I had a 51 year old today...FIFTY ONE! Good lord

I'll give the pt credit for being alive though, I had to actually ask the Dr. to explain to me how the pt was getting blood flow to the lungs because I could absolutely not picture it in my head (unrepaired asd/vsd/tricuspid atresia/hypoplastic right heart...and all the long term complications that come with that too)

hiddencatRN, BSN, RN · May 12, 2012

My hospital doesn't admit adults unless they came in through the ER so unstable that transfer is out of the option or there are no adult services for them. With many of the complex cardiac patients, they're only just now starting to live in to adulthood, so adult facilities don't know the ins and outs of caring for them yet. That I can understand. But if there's care at an adult facility, and they are stable, we transfer them.

canned_bread · May 18, 2012

Wow! At our paediatric hospital we have a transition program to get them to an adult facility. The only time we see adults is when they are pregnant with a child who is going to be a patient in our hospital OR if the child is potentially going to pass away prior to ever getting use of transitioning. In ED we take kids up to 15 years and 9 months (unless known to us) and transition them when they finish school (around 17).

The doctors taking care of a child who is not transitioning in the guidelines actually have to do a form and send it off to a department explaining why they are not transitioning and basically get it "approved". It comes down to funding I guess.

The oldest pt in my paeds hospital I have taken care of was 19 and was still there because he was SOOOOO complex, and wasn't expected to make it till 20. We all knew him so well anyway we didn't want him to go!!

student987 · May 20, 2012

I am actually a patient at a pedeatric hospital. I have a complex medical history and have been a patient there since I was 3. I have a genetic disorder (called Neurofibromatosis) that there are only 2 groups of docs who treat it in the state. there are 3 types of my disorder (actually all completly different but called the same disorder) and my doc's group focuses on my type. The other group focus' on one of the other types.

I also see lots of other docs, but because that doc is there it is better to have everyone there so that they can all talk easily because my disorder can cause problems with any system at any time.

anon456, BSN, RN · May 20, 2012

I work at a stand-alone peds hospital that is not attached to any adult hospital. We get the cardiac/congenital defects patients mentioned already on this thread. We also will get some patients that had their life-changing event (head trauma, etc) as a child and the family is more comfortable with our set of MD's because they know the patient so well. We have had patients in their early 20's that fit into that category. I'm sure they must phase them to adult medicine at some point. . .

We have had a couple of very much older patients who had rare congenital syndromes and the only MD's available in our geographical location who are familiar with those are peds MD's. Usually those patients are very much cognitively impaired and their mental/emotional needs are easily handled by us. The ones I've cared for are also smaller in stature, more "kid-like" in many ways.

bridgetclare · Jul 1, 2012

I have been doing a placement in adult respiratory and we get all the paeds for lung transplants. All the nurses have been doing extra training, but it's tricky to adjust. We get all the CF patients when they are over 18 though.

NicuGal, MSN, RN · Jul 4, 2012

We have a huge comprehensive care service, so they all come back to the comprehensive peds floor as that is where their docs are.

sergel02, BSN · May 3, 2015

It's interesting hearing about stories like this.

One of the hospitals in my area takes patients up to 20 if they need them, like the heart folks. And overflow.

As a future nurse, I really would love to work the entire spectrum of age since it seems interesting, but I think the only area for that might be ER. As a parent of, say a 16 year old, I might be uncomfortable with having adult patients on the same unit as my kid, at least the ones that don't need to be there.

I had a tough time transitioning just from the pediatric doctors office to adult, but I'm glad my doctor did it the way he did, since I really like my adult physician now. I feel like the transition for some patients and families can be hard since they are comfortable and used to the pediatric ward.

~PedsRN~, BSN, RN · May 5, 2015

We get adults if they are still followed by pediatric physicians. So that would be your chronic kids, heart kids, etc - that keep the same doctors for quite awhile. But I've never taken care of one older than about 21.

~PedsRN~, BSN, RN · May 5, 2015

What chaps my behind more than taking care of a young adult is a kid that should just NOT be in a pediatric hospital. Like the 17 year old married mom to two. Or the drive by shooting gang member.

sergel02, BSN · May 5, 2015

What chaps my behind more than taking care of a young adult is a kid that should just NOT be in a pediatric hospital. Like the 17 year old married mom to two. Or the drive by shooting gang member.

I always wondered why some kids in the late teens are seen in the pediatrics ward, excluding pediatric ailments. What I mean is are they there for more legal reasons, or is their physiology really that different from an adult (many teens are treated as adults when it comes to certain procedures and medications)?

Pediatric Critical Care Columnist · May 5, 2015

eYoung adults who were born with congenital cardiac defects, spina bifida, gastroschisis/omphalocele, biliary atresia leading to liver transplant and all those ex-prems out there with long-term sequelae as well as those who had pediatric cancers will be followed into adulthood by pediatric specialists. True, their bodies will be physiologically those of adults, but education of physicians who only treat adults has lagged behind advances in pediatric care. So there aren't that many general practitioners or specialists who are familiar with and know how to manage serious conditions that emerge in childhood.

Like ~PedsRN~, I get a little choked when I find a 17 or 18 year old on our unit who clearly would be better off on an adult unit. When you have a teenaged mom who is not legally able to consent to her own care but is not only able but required to consent to care for her baby, it gets quite convoluted. I can guarantee that she didn't deliver or recover from that delivery on a peds unit. And how safe do you think parents of other patients feel when they see a teenaged gang member who has been beaten, shot or stabbed handcuffed to a bed? We fail a lot of people when we admit a 15 or 16-year-old post-MVC with critical traumatic brain injury who will almost certainly progress to brain death to a PICU where management of organ donors is quite different than on an adult unit... and much less frequent. Then too, what older teen is going to like being surrounded by babies, toddlers and pre-schoolers? Sometimes that kind of reasoning should be used when deciding where to send an older teen.