{
  "abstract": "Background Delivering care beyond hospital walls requires innovation, meticulous planning, and strong partnerships. This case describes collaboration between Great Ormond Street Hospital (GOSH) and Crystal House, an adolescent psychiatric inpatient unit within Central and North West London NHS Foundation Trust (CNWL), to provide care for a 15.9-year-old girl with complex medical, developmental, and mental health needs detained under Section 3 of the Mental Health Act. With her transition from the unit approaching, timely access to essential dental treatment under general anaesthetic (GA) was critical. Planning The GOSH Dental Team, Clinical Nurse Specialist (CNS), and Neurodisability teams coordinated a ‘piggyback’ GA admission, combining extensive dental restorative care with blood tests, nail care, and an echocardiogram. A virtual multidisciplinary team (MDT) included anaesthetics, neurology, cardiology, disability, recovery, HATS, Panther ward, admissions, and CNWL staff to design a personalised plan.Procedures and Adaptations Key measures included:Bespoke transport with enhanced staffing, pre–transfer medication, and contingency planningFamiliar carers supporting anaesthetic induction, using strategies effective in previous admissionsRecovery in theatre before quiet ward transfer, avoiding busy environmentsEnvironmental adaptations including a mattress–only bed space, equipment removal, and prioritised cubicle allocationDelivery The Dental, Anaesthetic, Cardiology, and Neurodisability teams seamlessly delivered all procedures in a single admission, with CNWL staff providing continuous support. Meticulous advance preparation ensured smooth transfer, safe induction, and patient-centred care throughout.Impact This GA piggyback model demonstrates how GOSH extends care by aligning specialist expertise with psychiatric and community partners. It reduced repeated hospitalisations, promoted equity of access, and safeguarded patient dignity. Grassroots initiatives, including personalised support from Crystal House staff, ensured the patient’s needs were met compassionately. The collaboration of teams within GOSH and externally was central to success, showing how cross-service working can achieve transformative outcomes for adolescents with complex needs, delivering measurable improvements in patient care.",
  "authors": [
    {
      "affiliations": [
        "Great Ormond Street Hospital for Children NHS Foundation Trust, UK"
      ],
      "name": "Disha Khemani"
    },
    {
      "affiliations": [
        "Great Ormond Street Hospital for Children NHS Foundation Trust, UK"
      ],
      "name": "Kirsten Simpson"
    },
    {
      "affiliations": [
        "Great Ormond Street Hospital for Children NHS Foundation Trust, UK"
      ],
      "name": "Katie Hill"
    },
    {
      "affiliations": [
        "Great Ormond Street Hospital for Children NHS Foundation Trust, UK"
      ],
      "name": "Kunal Patel"
    },
    {
      "affiliations": [
        "Great Ormond Street Hospital for Children NHS Foundation Trust, UK"
      ],
      "name": "Rosie Whatling"
    },
    {
      "affiliations": [
        "Great Ormond Street Hospital for Children NHS Foundation Trust, UK"
      ],
      "name": "Rosheen Fatima"
    },
    {
      "affiliations": [
        "Great Ormond Street Hospital for Children NHS Foundation Trust, UK"
      ],
      "name": "Aisha Hassen"
    }
  ],
  "title": "152 Care beyond walls: A collaborative piggyback GA for complex adolescent care",
  "uid": "67eea9aa-d749-5377-b4f4-298d86c5df51"
}