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Toriola E, Biviano L, Lau C, Hooke N, Donnelly A, Dickins E, Pengilly S, Ging J, Shaw N, Singh J. Advancing Pediatric Care: The virtualKIDS Experience in Nursing-Led Audio-Visual Clinical Services. Creat Nurs 2024; 30:118-124. [PMID: 38600876 DOI: 10.1177/10784535241245667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
During the COVID-19 pandemic, the escalating trend of pediatric patients, particularly non-urgent cases, going to the emergency departments (EDs) in New South Wales, Australia, prompted the establishment of virtualKIDS, a nursing-led telehealth service. This service, initiated in June 2021, operates 24/7 and provides comprehensive care through audio-visual consultations emphasizing a patient-centered approach. Three elements-COVID-19 Outpatient Response Team (CORT), virtualKIDS Acute Review (vKAR), and Virtual Urgent Care (VUC)-addressed specific needs during and beyond the pandemic, showcasing the adaptability and impact of virtual care. vKAR focuses on post-discharge support, allowing families access to telehealth for up to three days. Preliminary data indicates a 44% reduction in ED visits within 48 h. VUC employs nursing-led triaging paired with audiovisual assessment, demonstrating a 69% hospitalization avoidance rate. Hybrid ambulatory models such as a sleep study at home project, day-only tonsillectomies, and arthroscopic knee surgeries showcase innovative approaches to reducing hospital admissions and enhancing patient outcomes. This paper presents the evolution and diverse models of care implemented by the virtualKIDS service, offering insights into its potential as a nursing-led alternative to ED visits in acute-care pediatrics.
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Affiliation(s)
- Eunice Toriola
- virtualKIDS, Sydney Children's Hospital Network, Sydney, Australia
| | - Lyn Biviano
- virtualKIDS, Sydney Children's Hospital Network, Sydney, Australia
| | - Christine Lau
- Integrated Care Service, Sydney Children's Hospital Network
| | - Natalie Hooke
- virtualKIDS, Sydney Children's Hospital Network, Sydney, Australia
| | - Amie Donnelly
- virtualKIDS, Sydney Children's Hospital Network, Sydney, Australia
| | - Emma Dickins
- virtualKIDS, Sydney Children's Hospital Network, Sydney, Australia
| | - Sandra Pengilly
- virtualKIDS, Sydney Children's Hospital Network, Sydney, Australia
| | - Joanne Ging
- virtualKIDS, Sydney Children's Hospital Network, Sydney, Australia
| | - Nadine Shaw
- virtualKIDS, Sydney Children's Hospital Network, Sydney, Australia
| | - Jagdev Singh
- virtualKIDS, Sydney Children's Hospital Network, Sydney, Australia
- Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
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Lingam R, Smithers-Sheedy H, Hodgson S, Hutchinson K, Meyers Morris T, Hu N, Nassar N, Schroeder EA, Rana R, Dickins E, Bula K, Zurynski Y. Evaluation of RuralkidsGPS; A Novel Integrated Paediatric Care Coordination Model of Care in Rural Australia - a Mixed-Methods Study Protocol. Int J Integr Care 2023; 23:10. [PMID: 38020416 PMCID: PMC10668883 DOI: 10.5334/ijic.7008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 10/31/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction The Kids Guided Personalised Service (KidsGPS) is an integrated model of care coordination for children and young people (CYP) living with medical complexity. After successful implementation in an urban setting, the model of care will be rolled-out at scale to four rural regions in New South Wales, Australia to establish RuralKidsGPS. This paper describes the approach and methods for the outcome and implementation evaluation of RuralKidsGPS. Description The evaluation aims to assess health, economic and implementation outcomes and processes whilst identifying barriers and enablers to inform future rollouts. Measures of health service utilisation (primary outcome), child health related quality of life and parent/carer experiences will be assessed. The implementation evaluation will occur alongside the outcomes evaluation and is underpinned by the Consolidated Framework for Implementation Research and informed by validated quantitative measures and qualitative interviews with patients, families, healthcare providers and service managers. An economic analysis will determine incremental cost effectiveness ratios for the new model of care using health service utilisation data. Conclusion RuralKidsGPS, if effective, has the potential to improve equity of access to integrated care for CYP and their families and this protocol may inform other evaluations of similar models of care delivered at scale.
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Affiliation(s)
- Raghu Lingam
- Population Child Health Research Group, School of Women’s and Children’s Health, University of New South Wales, Sydney, NSW, Australia
- The Sydney Children’s Hospitals Network, Sydney, NSW, Australia
| | - Hayley Smithers-Sheedy
- Population Child Health Research Group, School of Women’s and Children’s Health, University of New South Wales, Sydney, NSW, Australia
| | | | - Karen Hutchinson
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Tammy Meyers Morris
- Population Child Health Research Group, School of Women’s and Children’s Health, University of New South Wales, Sydney, NSW, Australia
- Department of Community Paediatrics, Sydney Children’s Hospital, Randwick, NSW, Australia
| | - Nan Hu
- Population Child Health Research Group, School of Women’s and Children’s Health, University of New South Wales, Sydney, NSW, Australia
| | - Natasha Nassar
- Child Population and Translational Health Research, Children’s Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Elizabeth-Ann Schroeder
- Macquarie University Centre for the Health Economy, Australian Institute of Health Innovation, Macquarie University, Sydney NSW 2113, Australia
| | - Rezwanul Rana
- Macquarie University Centre for the Health Economy, Australian Institute of Health Innovation, Macquarie University, Sydney NSW 2113, Australia
| | - Emma Dickins
- The Sydney Children’s Hospitals Network, Sydney, NSW, Australia
| | - Kirsten Bula
- The Sydney Children’s Hospitals Network, Sydney, NSW, Australia
| | - Yvonne Zurynski
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
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Hodgins M, van Leeuwen D, Braithwaite J, Hanefeld J, Wolfe I, Lau C, Dickins E, McSweeney J, McCaskill M, Lingam R. The COVID-19 System Shock Framework: Capturing Health System Innovation During the COVID-19 Pandemic. Int J Health Policy Manag 2022; 11:2155-2165. [PMID: 34814662 PMCID: PMC9808299 DOI: 10.34172/ijhpm.2021.130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 09/07/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) has resulted in over 2 million deaths globally. The experience in Australia presents an opportunity to study contrasting responses to the COVID-19 health system shock. We adapted the Hanefeld et al framework for health systems shocks to create the COVID-19 System Shock Framework (CSSF). This framework enabled us to assess innovations and changes created through COVID-19 at the Sydney Children's Hospitals Network (SCHN), the largest provider of children's health services in the Southern hemisphere. METHODS We used ethnographic methods, guided by the CSSF, to map innovations and initiatives implemented across SCHN during the pandemic. An embedded field researcher shadowed members of the emergency operations centre (EOC) for nine months. We also reviewed clinic and policy documents pertinent to SCHN's response to COVID-19 and conducted interviews and focus groups with stakeholders, including clinical directors, project managers, frontline clinicians, and other personnel involved in implementing innovations across SCHN. RESULTS The CSSF captured SCHN's complex response to the pandemic. Responses included a COVID-19 assessment clinic, inpatient and infectious disease management services, redeploying and managing a workforce working from home, cohesive communication initiatives, and remote delivery of care, all enabled by a dedicated COVID-19 fund. The health system values that shaped SCHN's response to the pandemic included principles of equity of healthcare delivery, holistic and integrated models of care, and supporting workforce wellbeing. SCHN's resilience was enabled by innovation fostered through a non-hierarchical governance structure and responsiveness to emerging challenges balanced with a singular vision. CONCLUSION Using the CSSF, we found that SCHN's ability to innovate was key to ensuring its resilience during the pandemic.
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Affiliation(s)
| | | | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Johanna Hanefeld
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Ingrid Wolfe
- Institute for Women and Children's Health, King's College London, London, UK
| | - Christine Lau
- Integrated Care Project, Sydney Children's Hospitals Network, Sydney, NSW, Australia
| | - Emma Dickins
- Integrated Care Project, Sydney Children's Hospitals Network, Sydney, NSW, Australia
| | - Joeanne McSweeney
- Integrated Care Project, Sydney Children's Hospitals Network, Sydney, NSW, Australia
| | - Mary McCaskill
- Integrated Care Project, Sydney Children's Hospitals Network, Sydney, NSW, Australia
| | - Raghu Lingam
- University of New South Wales, Sydney, NSW, Australia
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Homaira N, Dickins E, Hodgson S, Chan M, Wales S, Gray M, Donnelly S, Burns C, Owens L, Plaister M, Flynn A, Andresen J, Keane K, Wheeler K, Gould B, Shaw N, Jaffe A, Breen C, Altman L, Woolfenden S. Impact of integrated care coordination on pediatric asthma hospital presentations. Front Pediatr 2022; 10:929819. [PMID: 36210953 PMCID: PMC9537948 DOI: 10.3389/fped.2022.929819] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 08/22/2022] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Frequent asthma attacks in children result in unscheduled hospital presentations. Patient centered care coordination can reduce asthma hospital presentations. In 2016, The Sydney Children's Hospitals Network launched the Asthma Follow up Integrated Care Initiative with the aim to reduce pediatric asthma emergency department (ED) presentations by 50% through developing and testing an integrated model of care led by care coordinators (CCs). METHODS The integrated model of care was developed by a multidisciplinary team at Sydney Children's Hospital Randwick (SCH,R) and implemented in two phases: Phase I and Phase II. Children aged 2-16 years who presented ≥4 times to the ED of the SCH,R in the preceding 12 months were enrolled in Phase I and those who had ≥4 ED presentations and ≥1 hospital admissions with asthma attack were enrolled in Phase II. Phase I included a suite of interventions delivered by CCs including encouraging parents/carers to schedule follow-up visits with GP post-discharge, ensuring parents/carers are provided with standard asthma resource pack, offering referrals to asthma education sessions, sending a letter to the child's GP advising of the child's recent hospital presentation and coordinating asthma education webinar for GPs. In addition, in Phase II CCs sent text messages to parents/carers reminding them to follow-up with the child's GP. We compared the change in ED visits and hospital admissions at baseline (6 months pre-enrolment) and at 6-and 12-months post-enrolment in the program. RESULTS During December 2016-January 2021, 160 children (99 in Phase I and 61 in Phase II) were enrolled. Compared to baseline at 6- and 12-months post-enrolment, the proportion of children requiring ≥1 asthma ED presentations reduced by 43 and 61% in Phase I and 41 and 66% in Phase II. Similarly, the proportion of children requiring ≥1 asthma hospital admissions at 6- and 12-months post-enrolment reduced by 40 and 47% in Phase I and 62 and 69% in Phase II. CONCLUSION Our results support that care coordinator led integrated model of asthma care which enables integration of acute and primary care services and provides families with asthma resources and education can reduce asthma hospital presentations in children.
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Affiliation(s)
- Nusrat Homaira
- Discipline of Paediatrics and Child Health, Faculty of Medicine and Health, UNSW Sydney, Kensington, NSW, Australia.,Sydney Children's Hospital, Sydney, NSW, Australia
| | - Emma Dickins
- Integrated Care, Sydney Children's Hospital Network, Sydney, NSW, Australia
| | - Stephanie Hodgson
- Integrated Care, Sydney Children's Hospital Network, Sydney, NSW, Australia
| | - Mei Chan
- Discipline of Paediatrics and Child Health, Faculty of Medicine and Health, UNSW Sydney, Kensington, NSW, Australia
| | - Sandra Wales
- Sydney Children's Hospital, Sydney, NSW, Australia
| | - Melinda Gray
- Sydney Children's Hospital, Sydney, NSW, Australia
| | | | | | - Louisa Owens
- Sydney Children's Hospital, Sydney, NSW, Australia
| | | | | | - Jennifer Andresen
- Integrated Care, Sydney Children's Hospital Network, Sydney, NSW, Australia
| | | | - Karen Wheeler
- Central and Eastern Sydney Public Health Network, Sydney, NSW, Australia
| | | | - Nadine Shaw
- Sydney Children's Hospital, Sydney, NSW, Australia
| | - Adam Jaffe
- Discipline of Paediatrics and Child Health, Faculty of Medicine and Health, UNSW Sydney, Kensington, NSW, Australia.,Sydney Children's Hospital, Sydney, NSW, Australia
| | - Christie Breen
- Integrated Care, Sydney Children's Hospital Network, Sydney, NSW, Australia
| | - Lisa Altman
- Integrated Care, Sydney Children's Hospital Network, Sydney, NSW, Australia
| | - Susan Woolfenden
- Discipline of Paediatrics and Child Health, Faculty of Medicine and Health, UNSW Sydney, Kensington, NSW, Australia.,Integrated Care, Sydney Children's Hospital Network, Sydney, NSW, Australia
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Altman L, Breen C, Ging J, Burrett S, Hoffmann T, Dickins E, Brown K, Zurynski Y, Woolfenden S. "Dealing with the Hospital has Become too Difficult for Us to Do Alone" - Developing an Integrated Care Program for Children with Medical Complexity (CMC). Int J Integr Care 2018; 18:14. [PMID: 30245608 PMCID: PMC6144526 DOI: 10.5334/ijic.3953] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 08/15/2018] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Children with medical complexity (CMC) require highly specialised care, often from multiple providers and over many years. This paper describes the first 18 months of development of the Kids Guided Personalised Services (GPS) Integrated Care Program (the Program). This Program aims to improve health care experience; communication and to streamline provision of care. DISCUSSION Key enablers across the Program were put in place and 5 individual project streams were used to implement change. An extensive formative evaluation process was undertaken to truly understand all perspectives in developing the Program. CONCLUSION/KEY LESSONS This Program supports families who are caring for CMC by developing shared care models that bring together local health services with the tertiary hospitals. The methodology used has resulted in comprehensive system change and transformation; reduced presentations to the Emergency Department (ED), avoidable admissions and travel time. A challenge remains in meaningfully engaging primary health care providers.
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Affiliation(s)
| | | | | | | | | | | | | | - Yvonne Zurynski
- Sydney Children’s Hospitals Network, AU
- Macquarie University, AU
- University of Sydney, AU
| | - Susan Woolfenden
- Sydney Children’s Hospitals Network, AU
- University of New South Wales, AU
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Whiteman DC, Appleyard M, Bahin FF, Bobryshev YV, Bourke MJ, Brown I, Chung A, Clouston A, Dickins E, Emery J, Eslick GD, Gordon LG, Grimpen F, Hebbard G, Holliday L, Hourigan LF, Kendall BJ, Lee EY, Levert-Mignon A, Lord RV, Lord SJ, Maule D, Moss A, Norton I, Olver I, Pavey D, Raftopoulos S, Rajendra S, Schoeman M, Singh R, Sitas F, Smithers BM, Taylor AC, Thomas ML, Thomson I, To H, von Dincklage J, Vuletich C, Watson DI, Yusoff IF. Australian clinical practice guidelines for the diagnosis and management of Barrett's esophagus and early esophageal adenocarcinoma. J Gastroenterol Hepatol 2015; 30:804-20. [PMID: 25612140 DOI: 10.1111/jgh.12913] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/19/2014] [Indexed: 12/11/2022]
Abstract
Barrett's esophagus (BE), a common condition, is the only known precursor to esophageal adenocarcinoma (EAC). There is uncertainty about the best way to manage BE as most people with BE never develop EAC and most patients diagnosed with EAC have no preceding diagnosis of BE. Moreover, there have been recent advances in knowledge and practice about the management of BE and early EAC. To aid clinical decision making in this rapidly moving field, Cancer Council Australia convened an expert working party to identify pertinent clinical questions. The questions covered a wide range of topics including endoscopic and histological definitions of BE and early EAC; prevalence, incidence, natural history, and risk factors for BE; and methods for managing BE and early EAC. The latter considered modification of lifestyle factors; screening and surveillance strategies; and medical, endoscopic, and surgical interventions. To answer each question, the working party systematically reviewed the literature and developed a set of recommendations through consensus. Evidence underpinning each recommendation was rated according to quality and applicability.
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Affiliation(s)
- David C Whiteman
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
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