Outpatients reform in the Child Development Program

1. Outpatients reform in the Child Development Program 01March 2012

2. GP – Specialist Outpatient Project • Project Scope • 2 Year Project (2009 -2010) • Evaluation partner – UQ • Services in scope • Royal Brisbane & Women’s Hospital • Urology Outpatients • Ophthalmology Outpatients • Royal Children’s Hospital • Paediatric ENT • Child Development Program

3. GP – Specialist Outpatient Project • Aim of the project: • To assign GPs to work with outpatient services to: • Understand issues faced by staff and specialists in OPD clinics • Review current referral & discharge processes • Provide a GP perspective on referral and discharge processes • Collaboratively work toward reducing waiting list. • Achieve better continuity of patient care

4. Child Development Program • GP Advisor - Dr Dana Newcomb • Benchmarking nationally with services in Sydney, Melbourne, Perth, Gold Coast and Brisbane. • Literature review on child development shared care models • Interviews with senior CDP staff (Brisbane, Gold Coast, Sydney • Identification of issues contributing to long waiting lists

5. Issues Identified • Referral process • Lack of trust/understanding of roles • Internal processes

6. Referral Process GP Parent CDU Teacher Assessment of Referrals Other GP Referral Required

7. Lack of Trust & Understanding of Roles • Specialists did not discharge patients • Poor communication between specialists and GPs • Generally poor collaboration between CDP and GPs • Lack of GP knowledge about developmental disorders • Lack of GP awareness of other community resource options • Poor collaboration between Community Child Health Nurses and GPs

8. Internal Processes • New patients were required to be seen by the specialist prior to receiving any allied health services. • Wait times refer to the time waiting to see the specialist. • Wait times for allied services vary, but generally relatively lengthy.

9. Development of a GP Liaison Role • GP Liaison Officer - Lesley Martin • Work with the GP Advisor to: • Develop protocols which support Shared Care Model • Define referral guidelines • Maximise use of Information Technology • Identify alternative community resource options • Develop an early identification tool • Collect service utilisation data

10. Data Collection • Clinical diagnostic data was collected over a three month period to discern the highest primary diagnoses with a view to service planning • Austistic Spectrum Disorder • Pervasive Developmental Disorder as a secondary diagnosis • Intellectual impairment 50% of referrals in that time related to speech and language concerns of 0-2yr olds.

11. Outputs, Resources & Tools • The Red Flag Early Intervention Guide for children 0 – 5 years. • eReferral template developed • Clear referral guidelines published • Centralized referral assessment process • Feedback to GP process introduced • Dedicated GP phone number • Intake officer – alternate options • GP Liaison – 116 GP visits to 47 practices

12. Outcomes: Referral Process GP Parent CDU Teacher Assessment Report Assessment of Referrals Other

13. Outcomes • GP phone line utilised - 41% of phone calls received were from GPs. • 96% of GPs Surveyed were positive about the changes • Waiting times were reduced from over 12 months to 10 weeks

14. GP Perspective • Positive feedback from GPs • Laminated Red Flag Resource displayed in Practices/Treatment rooms • Practice visits well received • GP referrals more qualitative and inclusive of pre-determining factors • Secure messaging - direct referral link to central Clinical Intake at CDP

15. Paediatric Specialists’ Perspective • Raised awareness of GP role • Increased confidence to transfer review patients to GP care • Letters to GPs have become more structured • Recognition of enhancements achieved through electronic communication • Paediatric representation on Shared Care Working Party

16. Patient Perspectives • Improved continuity of care • Clearer referral pathway • More timely response to referral and appointment booking. • Enhanced transition into adulthood for patients with life-long complex developmental difficulties

17. In Summary • GP input into OPD processes has made a difference to waiting lists • Electronic communication between OPD and GP has streamlined processes • This project has assisted with ongoing service planning

18. For more details...... • Helen Hoare • Health Service Liaison Manager • Metro North Brisbane Medicare Local • helen.hoare@mnbml.com.au