Bowel and bladder dysfunction (BBD) affects up to 6 per cent of children. The two often occur together and cause a great deal of distress for families. 

A large number of children with BBD are referred to the Royal Children's Hospital (RCH). Children may be seen in one (or more) of the following clinics: Gastroenterology, Renal, Paediatric Surgery, Urology, General Medicine, Encopresis or Child and Adolescent Mental Health.

Wait lists for these clinics range from seven months (Enuresis clinic) to 12 months (Renal clinic) and there are currently limited guidelines to assist triage and referral, and few clinical guidelines to direct practice.

Project aims

The project aims to:

1. Evaluate current practice at the RCH following referral for a child with BBD.
2. Review the evidence base and best practice nationally and internationally.
3. Identify areas of improvement at RCH with regard to access, efficiency and quality of care.
4. Streamline the RCH approach to children with BBD to improve patient experience.
5. Ensure development and implementation of best practice guidelines for excellent clinical care.
   

Approach

The project will implement a five-step approach:

1. Review current practice, and audit referral and care pathways for a child with BBD.
2. Review current best practice guidelines for faecal and urinary incontinence and constipation, both nationally and internationally.
3. Develop and pilot a new BBD model of care for RCH clinicians.
4. Develop web-based information for general practitioners to support their management of children in the community.
5. Implement a BBD model of care across RCH and evaluate impact.

Expected outcomes

This project is expected to improve the service delivered to patients and their families through more timely and streamlined care. Earlier treatment can reduce complications and reduce the negative psychological effects for children and their families.  

The project's evaluation measures include:

1. Reduced waiting times for first appointments when the new care pathway begins.
2. Reduced numbers of referrals for ‘simple’ incontinence (patients with a combination of single diagnosis, no prior treatment and short term dysfunction).
3. Reduced number of different clinics potentially available for a patient with faecal and/or urinary incontinence, and reduced variation in care.
4. Increased patient and family satisfaction from wait list through to receiving the service.

Sustainability

The project flows through to an implementation phase in 2018 so that processes are sustainably changed without the need for ongoing coordinator support. The two-year timeline allows for sufficient time to develop the final products and processes, implement the proposed new model of care and evaluate impact.

Project team

Professor Sharon Goldfeld is a paediatrician and public health physician at the Centre for Community Child Health at the RCH. Professor Goldfeld has a research focus in community based systems change and implementing equity based community intervention trials in health and education.

Dr Susie Gibb is a paediatrician in the Department of General Medicine at the RCH and has a clinical and research interest in incontinence and constipation.

Associate Professor Sebastian King is a paediatric surgeon in the Department of Paediatric Surgery at the RCH with an interest in colonic disorders in children.  

For project inquiries, contact Sharon.Goldfeld@rch.org.au