In this section
RCH outpatient (OP) clinics see in excess of 270,000 children and the number of
referrals to RCH OP clinics has increased by 94% over the last six years.
have wait lists more than 12 months yet many families do not turn up to their
booked appointments. Similarly, there have been increasing numbers of children
presenting to emergency departments (EDs) across Victoria. Over the last
decade, paediatric referrals from general practitioners (GPs) to the ED have
increased by 60% in Australia. Children aged zero to four years now make up the
largest age category presenting in Victoria, far exceeding adults.
anecdotal evidence that many of these children could be safely managed outside
the hospital setting for their diagnosis and/or ongoing management. Directing children
away from the ED or OP clinics towards community-based care could improve
access to specialist care for children with more complex conditions. However, concern
exists regarding the skill level of community providers to manage health
The HSRU is
conducting a number of studies examining the interface between community care and
hospital OP clinics and ED.
Building on the
pilot study HSRU conducted in 2017-2019 (see Completed Projects below), the
Strengthening Care for Children (SC4C) project is a four-year stepped-wedge
randomised control trial funded through an NHMRC Partnership. The SC4C trial is
being conducted across Victoria and New South Wales in collaboration with the
Murdoch Children’s Research Institute, University of Melbourne, University of
New South Wales, Macquarie University, Sydney Children’s Hospital Network, North
Western Melbourne Primary Health Network, Central & Eastern Sydney Primary
Health Network, Agency for Clinical innovation (NSW Health) and Sydney
Partnership for Health, Education, Research and Enterprise (SHPERE).
The aims of the
SC4C trial are to reduce GP referrals to hospital Outpatient Clinics and
Emergency Departments, increase GP confidence in paediatric healthcare and
adherence to clinical guidelines, and decrease family preference for a
specialist paediatric referral.
collected data from Victorian public hospital Emergency Departments, this
project aims to examine pre-Covid-19 trends and characteristics of paediatric
ED attendances in Victoria. We will examine patterns of low urgency
presentations, high frequency attendees to ED, and chronic illness related
presentations, including diabetes-related attendances to ED to understand the
characteristics of these presentations and associated costs.
This project will establish trends in
paediatric ED attendances pre-Covid-19, and will allow for future research to
examine the impact of Covid-19 on paediatric health service use.
fail to attend (FTA) their appointment account for 23% of
all outpatient appointments in the General Medicine department of The Royal
Children’s Hospital (RCH). This equates to over 2500 wasted appointments every
year. With an increasing paediatric population and waitlists of up to two years
for these outpatient clinics, FTA appointments represent a large burden on
already limited resources.
aims to understand patient and system characteristics associated with FTA, as
well as the associated costs with FTA appointments. From there, we will develop
and test an appropriate intervention aimed at reducing FTA appointments.
We aim to
co-develop and pilot a new community based enuresis program in collaboration
with the General Medicine enuresis outpatient clinic at The Royal Children’s
Hospital (RCH), General Practitioners (GPs) and the North Western Melbourne
Primary Health Network (NWMPHN). We will evaluate whether the new program can
reduce the number of children who currently wait up to 18 months to be seen at
the RCH for primary nocturnal enuresis, when these children could be safely cared
for in the community. The community-based, nurse-led model will treat and
support children with primary nocturnal enuresis and identify children that
require specialist treatment.
Strengthening Care for Children (SC4C) study piloted an integrated general
practitioner (GP)-paediatrician model of care in 6 GP practices in north-west
Melbourne. Over 12
months, 49 GPs and 896 families participated in the intervention that included
weekly to fortnightly paediatrician-GP co-consultation sessions at the general
practice, monthly case discussions and telephone or email clinical support for
GPs. The model of care was found to be feasible and acceptable, lead to a lower
proportion of referrals to specialist paediatric care, and reduced unnecessary
prescribing of acid suppression therapy and antibiotics. GPs reported increased
confidence in paediatric care and, similarly, families reported increased
confidence in their GP.
The SC4C Pilot led to a successful application for an NHMRC Partnership Grant (see Current Projects above).
We know that up to 20% of
specialist outpatient clinic appointments are unattended, with families missing
their appointment for any number of reasons. This is despite very long wait
lists for appointments. We are interviewing families who had an appointment,
but did not attend, with the aim to find out why the appointment was missed so
that we can increase the efficiency of the outpatient clinics into the future.
Through this project, we will determine what we can do to help families get to
their appointment or to cancel it in time so that another child can be seen.
Over a 12 month period
spanning May 2015 to April 2016, we conducted an audit of the efficiency in use
of five outpatient clinics at RCH. We looked at differences in the availability
of new versus review appointments, and any differences in the proportion of the
available appointments that were booked in, and attended, by clinicians and
families. We found wide variation in clinic attendance but no seasonable
variation. ‘Review’ appointments were
less well attended by families than ‘new’
Prof Hiscock is conducting related projects through the Health Services research group at MCRI. You can read more about these projects here.
National: RCH; MCRI; University of Melbourne; Sunshine Hospital;
NWMPHN; Werribee Mercy Hospital; Department of General Practice, University of
Melbourne; Curve Tomorrow.
International: USA - University of Michigan, Child Health
Evaluation and Research Center (Prof Gary Freed) and Stanford University (Dr
Lee Sanders); Canada - Toronto Sick Kids (A/Prof Eyal Cohen) and (Prof Astrid Gutmann); Ireland – Trinity
College, Dublin (A/Prof Maria Brenner); UK – King’s College London (Prof Ingrid
Wolfe) and University College London (Dr Dougal Hargreaves); Sweden – Karolinska
Institute (Prof Anders Hjern).
Admitted Episodes Dataset (VAED); The Royal Children’s Hospital (RCH; Epic); Generic
Health Network Information Technology for the Enterprise (GRHANITE); Australian
Paediatric Research Network (APRN).
RCH Foundation; Better Care
Victoria (DHHS), MCRI.