Improving Transition Readiness Assessment Utilization for Adolescents with Sickle Cell Disease Through a Multidisciplinary Quality Improvement Initiative
Timesha Edwards, Venee Tubman, Titilope Fasipe, Codi Adams, Christina Andrew-Barnett, Amanda Gregg, Chasity Woodard, Jacquilene Lafleur, Diane Wilkins, Modupe Idowu, Oluwaseun OlaiyaAbstract
Background
The purpose of this quality improvement project was to enhance transition readiness among adolescents with sickle cell disease by increasing provider use of an existing transition readiness assessment (TRA) tool in the electronic medical record. We sought to address the problem of underutilized TRA documentation, which limits identification of transition gaps and targeted education. We hypothesized that standardizing TRA use would improve transition preparation. Our initial SMART aim was to increase the proportion of patients aged ≥16 years with documented TRAs to 50% by December 2025.
Methods
The study was conducted at the Texas Children’s Hospital Main Campus Hematology Clinic. Using a quality improvement (QI) design, a multidisciplinary team—including a nurse coordinator, advanced practice provider, patient navigator, social worker, pediatric and adult sickle cell physicians, and members of the SCD community advisory board—evaluated barriers to transition readiness assessment (TRA) use in the electronic medical record. The study population included adolescents with sickle cell disease receiving care in the clinic. Data were collected through review of EMR documentation to determine completion rates of TRAs for patients aged ≥16 years. A fishbone diagram and operational process map were developed to identify root causes of low TRA utilization. Descriptive analysis was used to assess baseline performance and measure change over time.
Results
A total of approximately 250 adolescents aged ≥16 years were eligible for transition readiness assessment (TRA) during the study period. In the six months prior to project initiation, no patients had TRA documentation in the electronic medical record (EMR). Prior to launching interventions, the team developed several support tools, including a written transition policy, a patient-facing infographic, standardized pre-visit distribution of transition materials, and a unified workflow for TRA completion and documentation. Following implementation, TRA completion steadily improved across Plan–Do–Study–Act (PDSA) cycles. PDSA Cycle 1, focused on nurse coordinator education, resulted in a median TRA completion rate of 40.5%. PDSA Cycle 2, which targeted provider education, did not lead to additional improvement (median 38.5%). PDSA Cycle 3, involving optimization of EMR documentation and nurse coordinator workflow, yielded the greatest impact, increasing the median completion rate to 48%, sustained through December 2025. As a process measure, between 28–39% of eligible patients received a completed TRA each month during the intervention period.
Conclusions
A structured, multidisciplinary QI approach led to rapid improvement in the use of an EMR-based transition readiness assessment for adolescents with SCD, increasing documentation from baseline absence to nearly 50%. Enhanced TRA utilization strengthens the clinic’s ability to identify gaps in disease knowledge and self-management skills that are critical factors for preventing complications and supporting a safe transition to adult care. Ongoing analysis of TRA responses will guide targeted interventions to further improve readiness, while continued PDSA cycles aim to optimize workflows and deliver more individualized transition support.