patients who don't age out

[anon456, BSN, RN]

I work in an area where I totally understand why some patients do not age out and are followed pretty much forever by peds doctors. These include congenital heart defects and rare syndromes. The oldest one of these patients was in their 40's, and it's not super uncommon to have people in their 20's come in for cardiac revisions of congenital heart defects. We also have total care teens who are contracted, get scoliosis and need spinal fusions as they grow. Fine.

However we have several patients who the RN's feel probably should have aged out at 18 to 20 years old. They are typically total care neuro devastated patients who had brain injuries. Usually it's hypoxic injury at birth, near drowning, head trauma, etc. These patients are just basically total care adults, and have no peds-related issues that I can see. They are contracted, sometimes trach/vent, need to be turned and suctioned but why are they still peds? Very heavy to care for, have facial and body hair, the females have periods. Usually they come in for respiratory infections or bowel obstructions which are typical of total care patients of all ages.

Peds patients have special needs with med dosing, growth and development issues, but total care adults need to be moved at some point to adult facilities in my opinion.

Does anyone else encounter this?

[Double-Helix, BSN, RN]

I see this frequently in my unit as well. It can certainly be frustrating, but usually there is either a political or a financial reason behind the admission. The PCP wants the patient on in a peds hospital because they have privileges there. The patient's surgeon or consulting MD is a pediatric specialist and wants the patient on a peds floor where they are more familiar with the staff and the staff are more familiar with them.

I try to tell myself that one more patient on our unit means a better census and thus, more job security. Although there certainly have been days when I've asked myself if I work in a pediatric or an adult ICU.

[Pediatricjo]

We have some "special" patients over the age of 18 that the pediatricians have aged out for us. There is a Pediatrician shortage in our town & they need the space in their practice. However, we have found that adult units do not always recognize the differences in developmentally delayed adults & adults with special needs & the rest of their adult population. They miss subtle changes. On the other hand, we get adult post-ops or medicals. We opt for the GYN post-surgicals.

[meanmaryjean, DNP, RN]

Wow - I've never cared for someone over 18 in our PICU.

[umcRN, BSN, RN]

I don't work in the PICU so I don't know how many older patients they have (though I did float there once and care for a 23 yr old duchenne muscular dystrophy pt) but working in the cardiac icu we get all the adult cardiac patients. We do have an adult congenital heart program and doctors specific to that program. They see patients out of the adult hospital next door however when admitted inpatient they come to the children's hospital. I highly dislike adult patients but I also understand why they are seen on our unit since adult cardiologists/intesivists don't typically have much experience with a Fontan circulation (or whatever special circulation the pt has) and how to manage complications.

My oldest patient to date was 53 and was an unrepaired hypoplastic right ventricle. 53 years ago the hospital sent her home with her parents to die and her body figured out a way to sustain itself. She's been married twice, adopted a few kids and worked a regular job. Bluest person I've ever seen!

[Katie13LPN]

I have not read all these comments but I think by law the cardiologist is supposed to follow them. I had a little girl with down syndrome. Her family told me that.

[xoemmylouox, ASN, RN]

I have not read all these comments but I think by law the cardiologist is supposed to follow them. I had a little girl with down syndrome. Her family told me that.

That makes no sense. I don't know of any such law, and I certainly hope there isn't any. Why would a physician HAVE to follow a patient? it drives me crazy when we have patients that have no business being in Peds. I get the adults with certain heart defects, spinal defects, etc. I don't get the brain damaged, mentally challenged, physically disabled, etc that we see into their 30's.

[KelRN215, BSN, RN]

I have not read all these comments but I think by law the cardiologist is supposed to follow them. I had a little girl with down syndrome. Her family told me that.

There is no law that says what kind of doctor must follow certain patients- or that patients must be followed by any doctor at all. Also who is this "them" that the law requires the pediatric cardiologist to follow?

The oldest patient I ever cared for working in a pediatric hospital was in his 30s. The medical floors got Cystic Fibrosis patients well into their 40s/50s. Those patients were allowed to remain patients at this hospital until they died. I believe Cardiology also got many adults with congenital heart disease who had long been repaired because adult cardiologists/cardiac surgeons have no idea what to do with their hearts/circulation.

That said, some of the patients who stuck around were just ridiculous. A 30 year old who had cancer as a child doesn't need to be seen at a pediatric hospital when they develop a new condition as an adult.

[kidzrn08]

Within the facility that I work, our PICU is the only pediatric heart center in the state and the cardiologist are the only congenital specialists in town. Therefore out PICU sometimes has 40 year old congenital heart patients because the cards MD's dont want them on the adult side. They claim those nurses do not know hot to care for these defects and have bad outcomes. On my unit (peds med/surg/onc) we phase out our older kiddos at about 19ish depending on the patient. Some of our CF kids that we have had for years we let stay until the "teen" goes out of their age...we also continue to treat our cancer kiddos if they're a new diagnosis close to their 18th birthday but these are by vote of the staff. Everyone else gets phased into the adult world. I think it's the right thing to do but sad that I know for a fact some of our DD kiddos that were frequent bowel obstructions and such have passed on the adult side due to what I would describe as neglect. While they should get the same care a peds nurse would provide, I think we are a different breed of nurses and our standards direct that.