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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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Jones B, Woolfenden S, Pengilly S, Breen C, Cohn R, Biviano L, Johns A, Worth A, Lamb R, Lingam R, Silove N, Marks S, Tzioumi D, Zwi K. COVID-19 pandemic: The impact on vulnerable children and young people in Australia. J Paediatr Child Health 2020; 56:1851-1855. [PMID: 32931623 DOI: 10.1111/jpc.15169] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/20/2020] [Accepted: 08/12/2020] [Indexed: 01/25/2023]
Abstract
The COVID-19 pandemic and associated system disruptions are impacting all children and young people (CYP) in Australia. For vulnerable groups of CYP, who already experience poorer health and well-being, these impacts are amplified. Challenges include reduced access to usual services, reduced community supports, financial instability, unemployment and other life circumstances that threaten to widen pre-existing inequities. This article aims to present the reasons for vulnerability of CYP during the pandemic, and to focus on actions by health professionals that mitigate additional challenges to their health and well-being. Using a rapid review of the literature and team-based discussions, eight vulnerable groups were identified: CYP with disabilities, mental health conditions and chronic diseases; CYP facing financial hardship; within the child protection system; Aboriginal; migrant and refugee; in residential care; rural; and isolated CYP. Recommendations for action are required at the level of governments, health professionals and researchers and include enhancing access to health and social supports, prioritising vulnerable CYP in resuming health activity and elevating the voice of CYP in designing the response. The pandemic can be conceptualised as an opportunity to create a more equitable society as we document the inequities that have been exacerbated. Vulnerable groups of CYP must be recognised and heard, and targeted actions must focus on improving their health outcomes during the pandemic and beyond.
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Affiliation(s)
- Benjamin Jones
- Community Child Health, Sydney Children's Hospital Network (Randwick and Westmead), Sydney, New South Wales, Australia.,UNSW, Sydney, New South Wales, Australia
| | - Susan Woolfenden
- Community Child Health, Sydney Children's Hospital Network (Randwick and Westmead), Sydney, New South Wales, Australia.,UNSW, Sydney, New South Wales, Australia
| | - Sandra Pengilly
- Community Child Health, Sydney Children's Hospital Network (Randwick and Westmead), Sydney, New South Wales, Australia
| | - Christie Breen
- Community Child Health, Sydney Children's Hospital Network (Randwick and Westmead), Sydney, New South Wales, Australia
| | - Richard Cohn
- Community Child Health, Sydney Children's Hospital Network (Randwick and Westmead), Sydney, New South Wales, Australia.,UNSW, Sydney, New South Wales, Australia
| | - Lyn Biviano
- Community Child Health, Sydney Children's Hospital Network (Randwick and Westmead), Sydney, New South Wales, Australia
| | - Adam Johns
- Community Child Health, Sydney Children's Hospital Network (Randwick and Westmead), Sydney, New South Wales, Australia
| | - Andrea Worth
- Community Child Health, Sydney Children's Hospital Network (Randwick and Westmead), Sydney, New South Wales, Australia
| | - Robyn Lamb
- Community Child Health, Sydney Children's Hospital Network (Randwick and Westmead), Sydney, New South Wales, Australia
| | - Raghu Lingam
- Community Child Health, Sydney Children's Hospital Network (Randwick and Westmead), Sydney, New South Wales, Australia.,UNSW, Sydney, New South Wales, Australia
| | - Natalie Silove
- Community Child Health, Sydney Children's Hospital Network (Randwick and Westmead), Sydney, New South Wales, Australia
| | - Susan Marks
- Community Child Health, Sydney Children's Hospital Network (Randwick and Westmead), Sydney, New South Wales, Australia
| | - Dimitra Tzioumi
- Community Child Health, Sydney Children's Hospital Network (Randwick and Westmead), Sydney, New South Wales, Australia
| | - Karen Zwi
- Community Child Health, Sydney Children's Hospital Network (Randwick and Westmead), Sydney, New South Wales, Australia.,UNSW, Sydney, New South Wales, Australia
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Nyanga R, Biviano L, Warren S, Windsor J, Zwi K, Gunasekera H. Aboriginal and Torres Strait Islander health-care delivery: The views of health-care professionals in Sydney's tertiary paediatric hospitals. J Paediatr Child Health 2018; 54:1023-1030. [PMID: 30008183 DOI: 10.1111/jpc.14072] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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] [Received: 09/13/2017] [Revised: 01/28/2018] [Accepted: 03/18/2018] [Indexed: 11/29/2022]
Abstract
AIM To determine the cultural competency training, knowledge and attitudes of health professionals about Aboriginal and Torres Strait Islander (hereafter referred to as Aboriginal) health-care delivery. METHODS Survey of medical (n = 200), nursing (n = 200) and other health professionals (n = 210) working in two tertiary paediatric hospitals in December 2013. The main outcome measures were training in Aboriginal health-care delivery, knowledge of Aboriginal health and services, attitudes to identification of Aboriginal patients and suggested ways to improve health-care delivery to Aboriginal patients. RESULTS We received responses from 286 of 572 (50.0%) staff with valid emails: 75 medical, 88 nursing and 123 other health professionals. A minority reported receiving specific Aboriginal health training (126/286, 44.8%) and Aboriginal cultural competency training (106/286, 37.1%). Medical staff were less likely than others to report Aboriginal health-care training (P = 0.01), cultural competency training (P < 0.001) and that their training equipped them to manage Aboriginal patients (P = 0.04). Few medical staff reported a good/very good knowledge of the services provided by the Aboriginal Community Controlled Health Services (20.0%), the Federal Government Closing the Gap initiative (14.7%) or the Royal Australasian College of Physicians' Reconciliation Action Plan (8.0%). Only 62 of 286 (21.7%) staff agreed that they usually asked patients/parents whether they identified as Aboriginal. Although 256 of 286 (89.5%) agreed that Aboriginal staff were an important resource, only 125 of 286 (43.7%) had referred Aboriginal patients to one. CONCLUSION The opportunities we have identified to improve health-care delivery to Aboriginal patients include: increasing Aboriginal cultural competency training, correct identification of Aboriginal patients, referring Aboriginal patients to Aboriginal health-care services and increased awareness of Aboriginal Community Controlled Health Services.
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Affiliation(s)
- Rita Nyanga
- Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Lyn Biviano
- Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Shirley Warren
- Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Josie Windsor
- Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Karen Zwi
- Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Hasantha Gunasekera
- Sydney Children's Hospitals Network, Sydney, New South Wales, Australia.,Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia
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Attwood L, Rodrigues S, Winsor J, Warren S, Biviano L, Gunasekera H. Improving delivery of health care to Aboriginal and Torres Strait Islander children. J Paediatr Child Health 2015; 51:534-540. [PMID: 25363130 DOI: 10.1111/jpc.12756] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 09/12/2014] [Indexed: 11/28/2022]
Abstract
AIM To identify opportunities to improve health-care delivery for urban Aboriginal and Torres Strait Islander children requiring hospital admission and to determine their characteristics. METHODS We analysed all documentation of admissions of Aboriginal and/or Torres Strait Islander children to a tertiary paediatric hospital in 2010. We reviewed the medical records to determine whether the Aboriginal status of patients was known, whether Aboriginal and/or Torres Strait Islander children and their families were reviewed by Aboriginal staff during admission and whether basic health-care quality indicators were met, including documentation of anthropometry, ear examination findings, immunisation status and catch-up immunisation delivery. RESULTS In 2010, 543 (2%) patients admitted to the institution were identified as Aboriginal and/or Torres Strait Islander: 140/538 (26.0%) were from the first decile (most disadvantaged) on Socio-Economic Indexes for Areas index. Of all admitted children, 148/543 (27.3%) were referred to Aboriginal health professionals during admission, more when length of stay was greater than 7 days (61% vs. 23%, P < 0.001). There was documentation of weight in 533/543 (98.2%), ear examinations in 64/543 (11.8%), immunisations being not up to date in 126/543 (23%), catch-up immunisation given in 7/126 (5.6%), Aboriginal and/or Torres Strait Islander status in 8/543 (1.5%) medical and 1/543 (0.2%) nursing discharge summaries. CONCLUSIONS We have identified several opportunities to improve culturally appropriate health-care delivery for Aboriginal and Torres Strait Islander children admitted to hospital, including improved recognition of Aboriginal and/or Torres Strait Islander status of patients, improved access to Aboriginal health professionals and increased performance and documentation of basic anthropometry, ear examination and immunisation catch-up.
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Affiliation(s)
- Lucy Attwood
- Sydney Medical Program, Sydney Children's Hospitals Network (Westmead), Sydney, New South Wales, Australia
| | - Sarah Rodrigues
- Department of Paediatrics, University College London, London, United Kingdom
| | - Josephine Winsor
- Sydney Children's Hospitals Network (Westmead), Sydney, New South Wales, Australia
| | - Shirley Warren
- Sydney Children's Hospitals Network (Westmead), Sydney, New South Wales, Australia
| | - Lyn Biviano
- Sydney Children's Hospitals Network (Westmead), Sydney, New South Wales, Australia
| | - Hasantha Gunasekera
- Sydney Medical Program, Sydney Children's Hospitals Network (Westmead), Sydney, New South Wales, Australia.,Sydney Children's Hospitals Network (Westmead), Sydney, New South Wales, Australia
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