Our profile
Catchment Geography
RCH supplies health services to infants, children and adolescents from a 'local catchment', as well as to those living in other regions of metropolitan Melbourne, regional Victoria, Southern New South Wales & Tasmania. It also provides some health services to children and adolescents from other States and overseas.
While our 'local' catchment is not well defined, RCH separation data indicates that the primary 'local' catchment area for RCH is the metropolitan northwest region of Melbourne, including the statistical local areas (SLA's) of Melbourne, Brimbank, Sunshine, Maribyrnong, Banyule, Darebin, Northcote, Hume, Sunbury, Moonee Valley, Essendon, Moreland, Hobson's Bay, Altona, Whittlesea and Wyndham. Other SLA's with high utilisation rates for RCH services that are outside our 'local' catchment include Boroondara & Yarra Ranges.
Approximately 40% of all RCH separations are from the SLA's highlighted above, 80% are from the Melbourne metropolitan area and approximately 20% of all RCH separations are patients from regional Victoria, interstate and overseas.
RCH has a Statewide role in the provision of a variety of specialist tertiary paediatric services, which results in our 'catchment' expanding to a number of rural and regional locations. The majority of these services are provided on the RCH campus; however RCH also conducts a number of outreach clinics at major regional centres at regular times throughout the year.
Demographic Profile
Most of the patients admitted to RCH are infants and children aged 0-4 years (approximately 50%). Children aged 5-9 years make up 23% of admissions, children and young people aged 10-14 make up 18% of admissions and young people aged 15-19 make up 9% of admissions.
A breakdown of the ages of RCH patients by key service areas in 2004-2005 (Refer Table 2) shows:
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70% of inpatients are under 10 years old, with 26% being one year old or younger.
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11% of inpatients are over 15 years old.
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46% of emergency department presentations are two years old or younger
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32% of outpatient attendances were by infants and children aged 0-4 years
| Age Group | Outpatients % |
Inpatients % |
Emergency % |
Day Medical % |
Short Stay Unit % |
Day Surgery % |
PICU % |
| 0-4 years |
32.1
|
47.1
|
60.4
|
19.4
|
65.9
|
46
|
61.9
|
| 5-9 years |
23.8
|
22.5
|
20.7
|
22.2
|
20.6
|
27
|
18.2
|
| 10-14 years |
21.9
|
18.9
|
18.9
|
13.9
|
21.7
|
11
|
18.3
|
| 15-18+ Years |
22.1
|
11.3
|
5.1
|
26.7
|
2.3
|
8.6
|
8.5
|
Table 2: Percentage of Patients by Age Groups (2004-2005)
Data from RCH Interpreter and Non-English Speaking Background (NESB) Services indicates that approximately 30% of all RCH patients and their families are from a non-English speaking background. Provision of interpreter services has increased by 40% over the past few years; from 13,819 in 2002-3 to 19,322 in 2005-6. The top five languages for which the interpreter services are accessed are Vietnamese, Arabic, Dinks (Sudan), Cantonese and Somali. Interpreter services were provided for nearly 80 languages in 2005.
Approximately 1% of all RCH patients are Aboriginal or Torres Strait Islander.
RCH Services
RCH provides the full spectrum of medical and surgical paediatric services, as well as a number of specialist tertiary paediatric services and health promotion and prevention programs for infants, children and adolescents. These services are provided on both an inpatient and ambulatory basis. A detailed analysis of RCH's current service profile is available in Appendix B of the RCH Service Plan.
Currently, these services are provided within a divisional type structure reporting to 6 Executive Directors, a Chief of Surgery and a Chief of Medicine (Refer Strategic Plan Appendix 1 for current RCH Organisational Chart).
The RCH Service Plan also provides a detailed analysis of service activity and forecasts of that activity to 2016 .
Key Trends and Issues
The process of consultation and analysis undertaken for the RCH Service Plan and the RCH Master Planning process has identified a number of key trends and issues in relation to child and adolescent health, which will become the drivers for demand for RCH's services over the next 5-10 years. These include:
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Growth in new morbidity issues e.g. asthma, type 1 diabetes and obesity;
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Chronic illness and disability - increase in complexity, partly due to increased survival, but also due to the introduction of new technologies to assist in their management. For example, a child with cerebral palsy may have a gastrostomy, an intrathecal baclofen pump and be on CPAP at night;
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Increase in issues associated with mental illness, learning and behavioural problems and eating disorders and impact on service demand and provision, particularly for RCH services such as Mental Health (inc. child psychology & psychotherapy), the Centre for Adolescent Health and the Centre for Community Child Health;
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Low birthweight and prematurity of infants (and consequent increase in related conditions such as cerebral palsy);
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Trend to more conditions being treated on same-day basis, with multi-day patients now more acute and complex requiring longer lengths of stay - need to adjust models of service delivery - increasing the use of Home and Community Care services, short stay options (eg. Short Stay Unit), and other care options such as a Care by parent Unit;
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Trend to increased referrals to RCH for paediatric surgery, both less complex and complex, particularly in areas such as orthopaedics, neurosurgery, plastics and cardiac surgery, which has a flow on effect to areas such as theatre services, anaesthesia, PICU, medical imaging, allied health and emergency;
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Incomplete profile of transition services for adolescents into adult services. Whilst progress has been made to improve the timely transition of adolescents, in a number of scenarios there remains a lack of services available in adult facilities or the lack of a planned approach and effective co-ordination between RCH and adult services, which is inappropriate for both patient and provider;
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An increasing requirement for paediatric rehabilitation services. RCH has now established a rehabilitation service for children, however there is still a substantial amount of work required to progress the development and implementation of a Statewide paediatric rehabilitation service and appropriate paediatric rehabilitation facilities;
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Meeting the high level of unmet demand in the community for services for infants and children with common sleep, eating, learning and behavioural problems and those with persistent pain management issues. These infants and children require a model of service provision that is focused on these common issues linked with community resources, and including specialised nursing close to home, which is distinct from the model for 'sick' children in hospital;
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Keeping up with the accelerated development and application of technology across paediatric health care, for example gene therapy, surgical robotics, bone implants with growth factor, radiosurgery, artificial lungs, live donor transplants, day case spasticity management by injection of Botulinum Toxin, ITB;
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Reinforcing the increasing focus on patient safety as a determinant of service provision and the associated recognition of the relationship between critical mass and quality and safety;
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Responding to the increasingly consumer-driven health system including increasing demand for evidence-based practice on behalf of the consumer;
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Maintaining care quality and service levels with continued shortages of key health professionals, for example nursing staff, highly specialised medical staff and volunteers;
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Assessing and addressing the implications of trend to 'safe working hours' for clinical staff, for example restricted consecutive hours for surgical, medical or after hours staff;
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Providing high quality, safe, responsive and efficient services in a tight fiscal environment; and
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Interstate patients. RCH is a Nationally Funded Centre (NFC) for cardiac transplants, but is currently providing care for a range of other conditions for children from several other states.