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Updated: Jul 1, 2026

A Novel Approach for the Administration of Medications and Fluids in Emergency Scenarios and Settings
06:59

A Novel Approach for the Administration of Medications and Fluids in Emergency Scenarios and Settings

Published on: November 9, 2016

A clinical pathway for young adults with medical complexity in a pediatric emergency department

Erin K Benekos1, Shelby K Shelton2, Laura Sarff3

  • 1Division of Adolescent Medicine, Rady Children's Health Orange County, Orange, CA, USA; Department of Population Health, Rady Children's Health Orange County, Orange, CA, USA.

Journal of Pediatric Nursing
|June 29, 2026
PubMed

Insights

A new clinical pathway in pediatric emergency departments (PEDs) improved the identification and referral of young adults with medical complexity (YAMC) to transition services. This standardized approach enhances care coordination and reduces fragmentation for YAMC.

Area of Science:

  • Pediatric Emergency Medicine
  • Healthcare Quality Improvement
  • Transition of Care

Background:

  • Young adults with medical complexity (YAMC) frequently access pediatric emergency departments (PEDs), highlighting challenges in transition planning and adult care integration.
  • Pediatric systems often lack standardized methods for identifying YAMC and connecting them to essential transition services, leading to fragmented care and suboptimal outcomes.

Purpose of the Study:

  • To implement and evaluate a quality improvement project utilizing a clinical pathway within a PED.
  • The pathway aimed to standardize the identification, triage, and referral of YAMC to a dedicated transition clinic for readiness assessment and comprehensive care planning.

Main Methods:

  • A multidisciplinary team developed a clinical pathway specifically for adults aged 18 years and older with medical complexity.
  • During a 10-week implementation, the project monitored pathway adherence, referral success, consultation completion rates, development of transition plans, and referral-to-appointment wait times using statistical process control and descriptive statistics.

Main Results:

  • Out of 115 screened patients, 27 (23.5%) met criteria for medical complexity and were referred to the transition clinic.
  • Pathway adherence increased from 0% to 100% by week 9.
  • Nine patients (33%) completed consultations, including readiness assessments and transfer checklists, with wait times varying from 9 to 21 days based on insurance.

Conclusions:

  • Implementing a structured clinical pathway in a PED effectively improved the identification and referral process for YAMC requiring transition services.
  • Standardizing these transition processes within emergency settings can enhance care coordination, minimize fragmentation, and establish reproducible models for addressing the unique needs of YAMC across pediatric healthcare systems.
Abstract

Keywords:
Healthcare transitionMedical complexityPediatric emergency departmentYoung adult

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