NSW Paediatric Service Capability Framework

Summary This Guideline provides guidance and support within a safety and quality framework forthe provision of paediatric medicine and paediatric surgery services at site specific levels.This framework provides guidance to Local Health Districts for admission, escalation andback transfer regarding paediatric medicine and surgery for children services.

Document type Guideline

Document number GL2017_010

Publication date 01 June 2017

Author branch Health and Social Policy

Branch contact (02) 94617174

Review date 01 June 2022

Policy manual Not applicable

File number H17/11782

Status Active

Functional group Clinical/Patient Services - Baby and Child, Governance and Service Delivery

Applies to Local Health Districts, Public Health Units, Public Hospitals, Specialty Network GovernedStatutory Health Corporations

Distributed to Divisions of General Practice, Ministry of Health, NSW Ambulance Service, Public HealthSystem, Tertiary Education Institutes

Audience Paediatric Clinicians; Health Service Planners; Clinical Directors; Chief Executives

Guideline

Secretary, NSW HealthThis Policy Directive may be varied, withdrawn or replaced at any time. Compliance with this directive is mandatoryfor NSW Health and is a condition of subsidy for public health organisations.

GUIDELINE SUMMARY

GL2017_010 Issue date: June-2017 Page 1 of 1

NSW PAEDIATRIC SERVICE CAPABILITY FRAMEWORK

PURPOSE

Service capability describes the planned activity and clinical complexity that a facility is capable of safely providing. The NSW Paediatric Service Capability Framework (the ‘Framework’) identifies the scope of planned activity for each paediatric service capability level and provides a mechanism for Local Health Districts to assess the planned service capability of their facilities.

Facilities must be capable of providing, at a minimum, all the planned clinical services described for their level. The Framework supports the provision of high quality, safe and timely care for infants, children and adolescents as close to home as possible.

KEY PRINCIPLES

Paediatric medicine service levels range from no planned service to Level 6 in the major children’s hospitals.

Surgery for Children service levels range from no planned service to Level 6. Level 6 paediatric surgery is provided in specialist children’s hospitals where paediatric surgery and complex genetic and metabolic services are located. There is no level 5 Surgery for Children Service.

This Framework does not cover Level 6 services.

USE OF THE GUIDELINE

Local Health Districts are responsible for determining the paediatric service capability level of their facilities, taking into account the clinical support services available (e.g. pathology, diagnostic imaging).

The Framework also includes the Paediatric Service Capability and Surgery for Children self-assessment checklists for assessing the planned service capability of a facility and a methodology to assist in service planning and risk management for paediatric medicine and surgery for children.

The Framework is supported by the NSW Paediatric Service Capability Framework Companion Toolkit.

REVISION HISTORY

Version Approved by Amendment notes

June 2017 (GL2017_010)

Deputy Secretary, Strategy and Resources

New Guideline

ATTACHMENTS

1. NSW Paediatric Service Capability Framework: Guideline

NSW PAEDIATRIC SERVICE CAPABILITY FRAMEWORK

NSW Paediatric Service Capability Framework NSW Health 2

NSW MINISTRY OF HEALTH 73 Miller Street NORTH SYDNEY NSW 2060 Tel. (02) 9391 9000 Fax. (02) 9391 9101 TTY. (02) 9391 9900 For information on this document please contact: Health and Social Policy Branch

Email. HSPB-ICB@doh.health.nsw.gov.au www.health.nsw.gov.au/kidsfamilies/ This work is copyright. It may be reproduced in whole or in part for study or training purposes subject to the inclusion of an acknowledgement of the source.

It may not be reproduced for commercial usage or sale. Reproduction for purposes other than those indicated above requires written permission from the NSW Ministry of Health.

© NSW Ministry of Health 2017 SHPN (HSP) 160458 ISBN 978-1-76000-527-6 (online) Further copies of this document can be downloaded from the NSW Ministry of Health website http://www.health.nsw.gov.au April 2017

NSW Paediatric Service Capability Framework NSW Health 3

Contents

1. Executive Summary ....................................................................................................................... 4

2. About This Document .................................................................................................................... 6

3. Paediatric Services ........................................................................................................................ 9

3.1 Overview .................................................................................................................................... 9

3.2 Specialist Children’s Hospitals (Role Delineation Level 6)........................................................ 9

4. Paediatric Service Capability ...................................................................................................... 11

4.1 Paediatric Medicine .................................................................................................................. 11

4.2 Surgery for Children ................................................................................................................. 13

4.3 Key Enablers For High Quality Paediatric Care ...................................................................... 14

4.4 Service Scope .......................................................................................................................... 16

4.5 Risk Assessment ..................................................................................................................... 17

5. A Networked Approach to Paediatric Care ............................................................................... 18

5.1 LHD Approach to Local Networked Paediatric Care ............................................................... 18

5.2 Role of Children’s Healthcare Network and Clinician Peer Groups ........................................ 19

5.3 Consultation, Escalation and/or Transfer ................................................................................ 20

5.4 Rural and Remote Considerations .......................................................................................... 22

6. Consumer Perspectives .............................................................................................................. 23

7. Conclusion .................................................................................................................................... 23

Glossary .............................................................................................................................................. 24

References .......................................................................................................................................... 26

Appendix 1 - Key Interfaces in the Delivery and Further Development of NSW Paediatric Service Capability ...................................................................................................................................... 28

Appendix 2 - Paediatric Service Capability Operational Level Checklists .................................. 30

Appendix 3 - American Society of Anesthesiologists (ASA) Physical Status Classification System........................................................................................................................................................ 47

Appendix 4 - Indicative List of Surgery for Children...................................................................... 48

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1. Executive Summary

The NSW Health system covers a large geographical area and includes multiple and diverse health facilities across metropolitan, regional, rural and remote regions. Within this system the majority of paediatric acute care is delivered by facilities that are located away from the State’s three specialist children’s hospitals. The key driver for the introduction of the NSW Paediatric Service Capability Framework (Framework) was the need for local paediatric services to be delivered optimally; whether in rural, regional or metropolitan locations.

This Framework is a key component of Healthy, Safe and Well: A Strategic Health Plan for Children, Young People and Families 2014–24 and aligns with other central health plans, policy and standards including:

National Safety and Quality Health Service Standards

NSW 2021: A Plan to Make NSW Number One (Timely Access to Care, Tackling Childhood Obesity and On-time Admissions for Planned Surgery)

NSW State Health Plan Towards 2021

NSW Rural Health Plan Towards 2021

NSW Health Guide to the Role Delineation of Clinical Services (2016)

NSW Maternity and Neonatal Service Capability Framework

Developed by the NSW Ministry of Health in collaboration with NSW Health Pillars, Local Health Districts/Specialty Health Networks (LHD/SHN), and the State’s three specialist children’s hospitals - and building upon existing structures, standards, guidelines and quality frameworks, this Framework outlines a networked approach to connect and support paediatric acute care services to improve accessibility, equity and safe care as close to home as possible. Current and projected paediatric activity and service demands along with a review of variation in paediatric clinical practice and paediatric services capacity were considered in the development of this Framework.

Optimal paediatric service capability is achieved when care is provided within the appropriate level of service. This Framework has been developed to provide a quality and safety lens for paediatric services across NSW with LHDs being the target audience. As the designated tertiary/quaternary facilities for paediatric care, specialist children’s hospitals play an important role in providing support and leadership as part of the overarching service system, but Level 6 services are out of scope for this Framework.

With optimal paediatric service capability, the expected benefits for the system, each service and consumers are:

Enhanced service access as close to home as possible, supported by tiered networks

Appropriate, contemporary models of care with particular emphasis on safety and quality

Less demand on acute care resources due to integration and earlier intervention services across the system

Fewer hospitalisations of children allowing reallocation of resources to paediatric hospital and community services, including prevention and early intervention

Better value care as a result of more efficient use of higher level services

Increased parent/carer awareness of access to local services

This Framework provides a mechanism for LHDs to assess the planned service capability of their facilities. Each facility must be able to be provide all the clinical services described for their paediatric service capability level. LHDs should use the operational checklists provided in Appendix 2 Paediatric Service Capability Operational Checklists to assess their acute care paediatric health services, identify strengths and areas for improvement to enhance their service capabilities.

PAEDIATRIC SERVICE CAPABILITY describes the activity and clinical complexity

that a facility is capable of safely providing

RIGHT CARE RIGHT PLACE

RIGHT TIME

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The Paediatric Service Capability Operational Checklists (the Checklists - Appendix 2) supplement the NSW Paediatric Service Capability Framework by outlining the essential elements required by paediatric medicine and surgery for children services to function at each specific service capability level. It is envisaged any assessment or review of capability using the Checklists would be a desktop exercise led by senior management and health service planning in collaboration with representatives from paediatric medicine and surgery services, with sign off by the LHD Chief Executive. The Checklists can be used to: • assess current paediatric medicine and surgery for children service capability • assess capability to move to a higher level on an ad hoc, short term or permanent basis. It is acknowledged that when completing the Checklists, clinical or operational risks may be identified which will require a facility response as per PD 2015_043 Risk Management - Enterprise-Wide Risk Management Policy and Framework – NSW Health. The Checklists includes a section to record any comments and actions planned should clinical or operational risks be identified. A Companion Toolkit has been developed and is available separately at http://www.health.nsw.gov.au/kidsfamilies/

Each of the tools in the Companion Toolkit enables LHDs to assess particular aspects of a facility’s level of service capability:

Tool 1: Requirements for establishment and operation of paediatric short stay and acute review services

Tool 2: Requirements for close observation capability in paediatric wards

Tool 3: Emergency surgery for children: self-assessment to support implementation of LHD designated surgical sites and the emergency department algorithm

Tool 4: Self-assessment of paediatric clinical emergency response system and beyond facility escalation process

Tool 5: Involvement of paediatricians in the care of children in NSW hospitals

Tool 6: Requirements for child friendly and child safe health facilities

Tool 7: Children and adolescents in paediatric services requiring mental health care.

NSW Paediatric Service Capability Framework NSW Health 6

2. About This Document

For the purposes of this document ‘planned services’ refers to the planning used to develop and maintain services for a given population within the facilities in a Local Health District (LHD) or Specialty Health Network (SHN).

Throughout the document the term ‘child’ or ‘children’ is used to describe infants, children and young people up to their 16th birthday, which is the scope for this Paediatric Service Capability Framework.

The NSW Health Guide to Role Delineation of Clinical Services (2016) provides a framework that describes the minimum support services, workforce and other requirements for clinical services to be delivered safely. Service capability describes the planned activity and clinical complexity that a facility is capable of safely and consistently providing.

LHDs are responsible for determining the paediatric service capability level of their facilities taking into account the workforce and the clinical support services available e.g. pathology, diagnostic imaging. Hospital-based acute care required by children is often different to that of presenting adults due to the distinct differences in paediatric physiology, development, vulnerability, the nature of disease, and manner in which paediatric injuries present.

Paediatric Service Capability identifies the scope of planning for paediatric acute care activity for each service capability level across all service levels in NSW. This approach strongly aligns with the Premier’s Priority of Improving service levels in hospitals by providing timely access to emergency departments (ED) leading to better health outcomes for patients and by reducing and avoiding hospital stays through the strengthened use of tiered (LHD and state-wide) paediatric networks enabling right care, in the right place, at the right time. Other key NSW Health strategies including the NSW Health Integrated Care Strategy are also closely linked with this work to enable:

Connected care across sectors – tertiary, secondary, primary care and community care

Coordinated and integrated care with an identified coordinator role

Timely and safe escalation of care through clearly defined pathways

Equitable access to quality services in rural, remote and disadvantaged areas through outreach (outreach clinics and telehealth)

Continuity of care across the lifespan for children with chronic diseases including planned care to avoid unnecessary presentations and admissions

Multidisciplinary care for chronic disease – includes general paediatricians, paediatric specialists, paediatric nurses and paediatric allied health professionals

Transition of care from paediatric to adult services1

Implementation of standardised protocols and best practice guidelines to support care while at the same time enabling flexibility and innovation

Appropriately skilled staff as well as opportunities for up-skilling and continuing education for all personnel

Well-defined communication strategies within and between teams across all systems and facilities

Patient and family centred care that meets individual needs and takes the psychosocial context into account.

The Paediatric Service Capability Framework (Framework) was informed by NSW Health Policy Directives and Guidelines as well as current and projected activity data, consultations and site visits to each LHD, paediatric nursing and medical workforce information, and evidence checks on variation in paediatric clinical practice and paediatric services capacity.

The Variation in Paediatric Clinical Practice evidence check identified that variation in paediatric clinical care is widespread internationally and occurs across diseases, clinicians, healthcare settings and geographical regions and that unwarranted clinical variation is more common in paediatric units within general hospitals

1 See References for further information

NSW Paediatric Service Capability Framework NSW Health 7

compared with stand-alone children’s hospitals. Associated factors for unwarranted clinical variation include absence of or lack of awareness of clinical practice guidelines, lack of, high quality evidence to inform practice contributing to an increase in avoidable admissions, physician preference for care and differences in local and regional primary care systems.

The Paediatric Services Capacity evidence check identified a range of models of care including short stay units/observation units, primary care embedded within the hospital setting, paediatric response teams in adult hospitals, outreach service models (outreach visits and telehealth), multidisciplinary coordinated, integrated and planned complex/chronic care models to prevent acute admissions and transition of care models as mechanisms to reduce avoidable admissions.2

Consultations undertaken within each LHD identified a number of key considerations for paediatric healthcare including:

Inpatient paediatric care is provided in a broad range of hospitals

Over 80% of ED presentations for children occur outside the specialist children’s hospitals

Many children receive non-tertiary care outside their LHD of residence

The population of children is rising and will increase demand on paediatric services.

The Framework supports the provision of safe, appropriate and timely care for children as close to home as possible by:

Providing a shared and consistent understanding of the planned service capability of a facility at a particular level which will assist decision making on escalation of care, transfers, admissions and return transfers for paediatric services

Providing operational checklists for assessing the planned service capability of a facility

Supporting the appropriate use of paediatric facilities at all levels

Providing an approach to paediatric service planning and risk management.

This Framework focuses on capabilities required to deliver high quality safe paediatric acute care services for children aged 0-16 years. Beyond the scope of this Framework, six critical clinical interfaces were identified as being essential in providing a comprehensive picture of healthcare services for children. For further information, see Appendix 1 - Key Interfaces in the Delivery and Further Development of NSW Paediatric Service Capability.

LHDs should use the operational checklists provided in Appendix 2 to assess their acute care paediatric health services, identify strengths and areas for improvement to enhance their service capabilities.

A Companion Toolkit has been developed and is available separately at http://www.health.nsw.gov.au/kidsfamilies/

Each of the tools enables LHDs to assess particular aspects of a facility’s level of service capability:

Tool 1: Requirements for establishment and operation of paediatric short stay and acute review services

Tool 2: Requirements for close observation capability in paediatric wards

Tool 3: Emergency surgery for children: self-assessment to support implementation of LHD designated surgical sites and the emergency department algorithm

Tool 4: Self-assessment of paediatric clinical emergency response system and beyond facility escalation process

Tool 5: Involvement of paediatricians in the care of children in NSW hospitals

Tool 6: Requirements for child friendly and child safe health facilities

Tool 7: Children and adolescents in paediatric services requiring mental health care.

2 The full reports for Evidence Check Paediatric services capacity and Evidence Check Variation in paediatric clinical practice are available from www.saxinstitute.org.au.

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This Framework identifies the scope of planning paediatric acute care service capability for children and follows the same structure as the NSW Health Guide to the Role Delineation of Clinical Services (2016). Paediatric medicine has five service levels (2, 3, 4, 5 and 6) and surgery for children has four service levels (2, 3, 4 and 6). Level 6 paediatric services are housed within the State’s three specialist children’s hospitals and are referenced in Section 3. Diagram 1 illustrates the links between the two documents.

Diagram 1: Links between Service Capability and Role Delineation

Serv

ice

Cap

abili

ty

Complexity of care a facility can safely provide

Ro

le D

elin

eati

on

Medical and surgical support services required for care at that level

Ro

le L

evel

Designated Role Level

NSW Paediatric Service Capability Framework NSW Health 9

3. Paediatric Services

3.1 Overview NSW Health is committed to providing the best evidence-based, accessible, equitable, and affordable healthcare to children in all communities. Paediatric healthcare services in NSW are currently provided by a range of acute and subacute services including three specialist children’s hospitals, local public hospitals, multi-purpose services and private facilities.

The following table provides a snapshot of paediatric activity for children aged 0-16 years in NSW over the 2015/16 period.

Emergency Department presentations for NSW residents in NSW Public Hospitals

Total 614,662

81% occurred across LHDs

19% occurred at specialist children’s hospitals

12% were admitted

Inpatient separations for NSW residents in NSW Public Hospitals*

Total 166,292

67% provided by LHDs

33% provided by specialist children’s hospitals

* excluding unqualified neonates, ED only separations, private hospitals and NSW residents treated Interstate.

Albury Base Hospital is included in emergency department admissions and admitted patients.

Table 1: 2015/16 Paediatric Activity Snapshot

Helping local communities deliver locally-led services in response to the health issues of different communities aligns with the Premier’s Priority of Improving Service Levels in Hospitals and forms an integral part of the NSW State Health Plan. Delivering the best possible hospital-based acute care to children as close to home as possible not only benefits the child’s immediate health and wellbeing but also recognises the needs of their family. How we deliver this care is dependent upon the overall agility of the healthcare system and its innate ability to integrate individualised care requirements with services in a responsive, effective and efficient manner across a large geographical area.

3.2 Specialist Children’s Hospitals (Role Delineation Level 6) Although the services of the specialist children’s hospitals were not examined as part of developing this Framework, the interface between these hospitals and the non-tertiary paediatric services is vital in the delivery of coordinated, integrated care to children and their families.

The roles of children’s hospitals are recognised as encompassing research, education, advocacy and clinical service. The latter is largely focused on services described as tertiary/quaternary, where the need for one or more subspecialists, rarity or severity of the condition, complexity and/or dependency on technology determine that a critical mass of expertise and resources are required. Additionally, children’s hospitals appropriately provide non-tertiary services to a catchment of the population that lives in relative proximity to their location. New South Wales has three children’s hospitals. The Sydney Children’s Hospitals Network (SCHN) encompasses the Children’s Hospital at Westmead (CHW) and the Sydney Children’s Hospital at Randwick (SCH), while Hunter New England (HNE) LHD’s John Hunter Children’s Hospital (JHCH) is located in Newcastle.

There are a number of aspects to the critical interface between the tertiary/quaternary hubs and the range of non-tertiary services provided across NSW. These include mechanisms and pathways for escalation of urgent care, de-escalation and back transfer, clinical continuity and in particular supporting LHD capability in “shared care” or partnership models for managing chronic/complex illness. To support LHD capability, the children’s hospitals are aligned with the NSW Children’s Healthcare Network which has been designed in three distinct Regions (Northern, Western, Southern), one Region associated with each children’s hospital site. This arrangement reinforces the critical functions of the children’s hospitals as hubs of expertise, escalation, outreach and referral not only to their respective Regions but, as appropriate, in a state-wide or national capacity.

NSW Paediatric Service Capability Framework NSW Health 10

Clinicians based at the specialist children’s hospitals provide paediatric outreach services across NSW. These services involve specialised clinical services to patients or specialised education to local clinicians, and are provided face-to-face or remotely via telehealth facilities.

3.2.1 Emergency Care

It is recognised that in emergency situations hospitals may need to undertake care normally provided at a higher service capability than their planned services, including, but not limited to, the capacity to undertake emergency surgery. As part of emergency care the child may need to be transferred to a higher level service where appropriate facilities are available.

3.2.2 Historical NSW Paediatric Service Levels 1 to 5

The following table is based on the NSW Guide to Role Delineation of Health Services (2002) and provides an estimate of paediatric service capacity by service level across NSW in 2014. This baseline data reflects a mix of service levels with considerable capability in level 3 and 4 paediatric medicine and surgery and forms a platform for better understanding paediatric service capability going forward. It should be noted that the 2002 role delineation levels differ to those in the NSW Health Guide to the Role Delineation of Clinical Services (2016).

Paediatric Medicine

L1 L2 L3 L4 L5

161 18 22 22 5

Paediatric Surgery

L1 L2 L3 L4 L5

178 -* 31 17 2

* This table is based on the NSW Health Guide to the Role Delineation of Health Services (2002) where there was no Level 2 Paediatric Surgery.

Table 2: Estimated Total Number of Paediatric Services by Service Level (2014)3

As part of clinical and capital services planning, action is required by each LHD to reassign role levels (as appropriate) following the removal of level 1 Paediatric Medicine services and level 5 services for Surgery for Children from the NSW Health Guide to the Role Delineation of Clinical Services (2016). The revised guide to role delineation of clinical services also identifies a “Surgery for Children” service rather than the previous “Paediatric Surgery”.

There is variability in smaller facilities providing paediatric services across NSW. Some include a dedicated paediatric in-patient ward, while others do not. It is acknowledged that flexibility is required to take account of local circumstances; however at a minimum all must provide a paediatric safe area, as defined in this Framework and described in NSW Health PD2010_032 Children and Adolescents - Admission to Services Designated Level 1-3 Paediatric Medicine & Surgery and PD2010_033 Children and Adolescents - Safety and Security in NSW Acute Health Facilities (please note this document refers to the 2002 Role Delineation Guide).

3 Based on NSW Health Guide to the Role Delineation of Health Services (2002)

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4. Paediatric Service Capability

4.1 Paediatric Medicine Paediatric medicine is concerned with the health of infants, children, and adolescents, their growth and development and their opportunity to achieve full potential as adults. Whilst children may be admitted to healthcare facilities where there is no paediatrician or under the care of non-paediatric specialists for many reasons, it is important that these children, their parents/carers and the clinicians responsible for their care have access to paediatric advice, review and involvement. The extent of involvement may be advice and review of medications, fluids, pain management and assistance with procedures or more detailed clinical consultation if required. The clinicians primarily responsible for the care of the child are accountable for initiating this contact and the paediatrician on-call is accountable for responding to the request for assistance.

All children who are in a NSW Health facility for longer than 24 hours (and earlier for children identified at risk) should have a paediatrician involved in their care. The NSW Health PD 2013_049 Recognition and Management of Patients who are Clinically Deteriorating states that as part of local Clinical Emergency Response System (CERS) protocols each LHD should have at least one designated regional paediatric service hub (service capability a level 4 or 5), which is a point of advice, referral and paediatric expertise, with 24 hour a day/7 day a week ‘on call’ paediatric (medical) consultation available. Border LHDs may have an agreement with an interstate paediatric service hub.

4.1.1 Clinical (Medical) Lead of Paediatric Services

In each LHD there are organisational structures that include a senior management role, which is filled by either a clinician or non-clinician staff member and is accountable for the governance and strategy for paediatric services within that LHD. In addition, all LHDs are required to have a Clinical (Medical) Lead of Paediatric Services based at their service capability level 4 or level 5 paediatric services.

This Framework requires the Clinical (Medical) Lead of Paediatric Services and through them, the 24/7 delegated, rostered paediatricians at the levels 4 or 5 services to have responsibility and the authority to engage in the clinical care of children presenting and/or admitted to levels 4 and 5 services as well as the lower level facilities in their defined catchment area. Accordingly, the paediatrician on call at the service capability level 4 or 5 services must also be available for calls and consultations from the respective catchment clinicians. The designated Clinical (Medical) Lead of Paediatric Services or rostered delegate would not be expected to take over responsibility for the care of the child, but provide paediatric consultation, assist in decision making and support other medical practitioners. In all instances the admitting medical practitioner would remain accountable for the care of the child. Tool 5 in the companion toolkit provides LHDs with mechanisms for involving paediatricians in the care of children admitted to NSW public hospitals.

The overarching aim of the designated Clinical (Medical) Lead of Paediatric Services role is to assist in minimising the risk of adverse clinical outcomes for paediatric patients and provide safe, quality care as close to the child and family’s community as possible. When engaging with the designated Clinical (Medical) Lead of Paediatric Services across different sites, telehealth should be available to enhance the quality and accuracy of the consultation. The function of the role is to provide:

A paediatric approach to care for all paediatric patients regardless of the reason for admission or admitting service

A clear point of contact within the LHD for a remote, rural and regional medical officer with a critically unwell or deteriorating child requiring immediate paediatric consultation

A first point of contact for early consultation and joint decision making around the care of an unwell child

Guidance for medical and nursing staff about when remote, rural and regional facilities should consult with paediatricians

A single point of contact for parents/carers, health professionals and non-medical clinicians to escalate persistent concerns about the care of a child requiring paediatric consultation.

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4.1.2 Emergency Medicine

A large proportion of children treated in an Emergency Medicine Service do not require admission to hospital. Facilities that provide emergency care for children but do not admit children are expected to meet the requirements of the emergency medicine service, including escalation to higher level service when additional care or admission is required, network with higher level paediatric medical and surgical services in the LHD including:

24 hour access to specialist support services and advice

Documented processes for consultation, escalation and patient transfer organised with networked paediatric service and state-wide paediatric services, including the Newborn and paediatric Emergency Transport Service (NETS) and Ambulance Service NSW (or relevant interstate service provider)

Appropriate equipment for children (including resuscitation)

A workforce with appropriate skills to care for paediatric patients, including competence in recognising and managing deterioration and resuscitation of infants and children

The capability to identify and respond to children at risk of harm and those who have suffered alleged physical and/or sexual abuse or neglect

An identified Clinical (Medical) Lead of Paediatric Service in the LHD to support clinical care of paediatric patients.

4.1.3 Short-Term Follow-Up of Children Departing an ED or Other Acute Care Setting

Determination of a patient’s readiness for departure from an ED is a multidisciplinary process with ultimate responsibility resting with the senior ED medical officer and the nurse in charge of the shift or their delegate as per PD2014_025 Departure of Emergency Department Patients. Some children who depart an ED (discharged or did not wait) or other acute care settings, such as a paediatric ward, are at higher risk of clinical deterioration later and a process for short term follow up of these children should be in place to ensure their safety.

A factor in the decision to follow up a child may be the level of parental experience or perceived ability to manage their child’s illness or the perceived need for further support. The child’s care may be best addressed by overnight admission rather than using the option of follow up. This decision is made by the treating clinician.

Where any staff member has concerns in relation to the safety of the child’s home environment, discussion must take place with the Admitting Medical Officer (AMO) and paediatrician. Where required, use of the Mandatory Reporter Guide and consultation with the Child Wellbeing Unit must occur in line with NSW Health PD2013_007 Child Wellbeing and Child Protection Policies and Procedures for NSW Health.

Whichever option for short-term follow-up is chosen, nurses/medical staff require dedicated time to make contact with parents/carers to advise on follow-up that may be required for the child.

NSW Paediatric Service Capability Framework NSW Health 13

Diagram 2: Short term follow up options and patient groups

4.2 Surgery for Children Surgery for children includes surgery provided by general and specialist adult surgeons, as well as paediatric surgery provided by specialist paediatric surgeons. General and specialist adult surgeons also play an important role in the delivery of surgery for children, particularly in regional settings and in emergency situations. In rural NSW, emergency and non-tertiary planned surgery is largely undertaken by general surgeons, with the occasional exception of local or outreach operating lists performed by paediatric surgeons.

This Framework requires each service capability level of surgery for children service to ensure that there is an appropriate level of paediatric medicine service in the hospital to provide appropriate pre- and post-operative care to children and their families. This is generally achieved with the service capability level of paediatric medical services at the same as, or higher level than, the level of surgery for children .

Facilities with a lower level of paediatric medical service than the surgical service may undertake a risk assessment to determine if it is able to consistently undertake the higher level of complexity of surgical services.

4.2.2 Emergency Surgery

The emergency surgery component of the Surgery for Children in Metropolitan Sydney Strategic Framework (2014) is relevant to rural, regional and metropolitan facilities where children may present with urgent surgical needs. The implementation of the ED algorithm template is particularly important for safe and appropriate care and aims to support the early recognition of children with surgical presentations and the timely decision about the management and/or escalation of care. While initially developed to support metropolitan facilities, the algorithm template can be customised for use by any hospital in metropolitan and rural LHDs. Each LHD is expected to have at least one designated hospital providing emergency surgery for children to support care as close to home as possible. This Framework requires that designated facilities have an existing service capability level 4 paediatric medicine service on-site with an inpatient unit and 24/7 paediatrician roster to enhance safety and provide a range of supports for the surgical service. Tool 3 in the companion toolkit provides a checklist for facilities to assess local implementation of the ED algorithm template.

4.2.3 Planned Surgery

The Surgery for Children in Metropolitan Sydney Strategic Framework (2014) identified opportunities for enhancement of planned surgery for children closer to home. Additional LHD activity has been funded largely in ear, nose and throat and orthopaedic specialties. Further enhancement and development of planned general paediatric surgery performed by paediatric surgeons is being progressed as part of a hub-and-spoke collaborative approach between metropolitan LHDs and the Sydney Children’s Hospitals Network.

Short term follow up options may include one or more of the following:

A telephone call

An appointment with a GP

Review in the ED

Review in a paediatric short stay/acute review service

Review in a paediatric ward

A home visit

Referral to a Hospital in the Home program

A timely outpatient clinic or office appointment

Patients who may benefit from short term follow up include, but are not limited to:

Patients referred by ED staff following presentation to an ED

Infants under the age of one year

Patients that did not wait

Acute illness where subsequent course is unclear

Patients with abnormal investigations and/or pathology tests

Vulnerable patient groups

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4.3 Key Enablers For High Quality Paediatric Care This Framework identifies the following key enablers that are required to improve the delivery of safe, accessible and high quality paediatric services across NSW.

4.3.1 Child Friendly and Child Safe Health Facilities

While guidelines exist for physical design of facilities, it is the synthesis of child friendly service development and physical design principles which delivers an appropriate environment in which to care for paediatric patients. The requirements for child friendly and child safe health facilities apply across all areas where paediatric care is delivered, including but not limited to EDs, ambulatory care, short-stay units, operating suite and inpatient units.

Underpinned by recognition and response to the specific needs of children, the components listed below support LHDs in providing facility-based environments that are safe for children and their parents/carers and include:

Service development and facility design

Workforce

Operational considerations including safety, paediatric clinical practice guidelines and equipment.

4.3.2 Service development and facility design

All children must be in a paediatric safe bed in any part of the hospital. The minimum requirements for paediatric safe beds are provided as per PD2010_032 Children and Adolescents – Admission to Services Designated Level 1-3 Paediatric Medicine and Surgery (please note that this document refer to the 2002 Role Delineation Guide). The requirements of a paediatric safe bed are detailed in Tool 6: Requirements for child friendly and child safe health facilities.

In addition to the requirements for safe beds, PD2010_032 also outlines that Role Delineation Level 3 paediatric services must have a paediatric safe area or ward; Role Delineation Level 4 paediatric services and above must have a paediatric safe ward, and children and their parents/carers should have access to a dedicated space that supports their needs and includes, but is not limited to:

Areas for children in Emergency Departments, wards and clinics that are separate to and protected from thoroughfare of adult patients, while remaining easily observable by staff

Safety from potential risk from other patients, staff and visitors

Safety from dangerous equipment, medications or fluids, hot water and electrical injury

A toilet and bathroom not shared with adult patients

An appropriately equipped area suitable for the resuscitation of children

A separate area away from the child’s bed for conducting painful procedures

Furniture that meets Australian standards, including cots for children under 2 years of age

Consulting and examination areas which enable privacy and confidentiality

Age-appropriate equipment including wheelchair access

Appropriate facilities to care for children with behavioural and mental health presentations

Age-appropriate play equipment to meet the child’s developmental needs and for distraction purposes during procedures

An appropriate area for management of infectious patients and/or isolation of other patients as needed

Access to facilities that permit and encourage parents/carers to stay with their child and meet their own and their child’s needs for nutrition, rest and hygiene

Facilities for breastfeeding mothers which provide the option of privacy.

For further detailed information relating to facility design, refer to the Australasian Health Facility Guidelines which has health planning guidelines for a range of clinical units used by children, adolescents and their parents and carers.

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4.3.3 Workforce

Attracting, training and keeping highly skilled personnel is key to all NSW Health services, but is crucial in paediatrics where the wide range of skills and geography covered necessitates a flexible, skilled and culturally competent workforce with ready access to training, best practice knowledge and specialist advice. This Framework outlines workforce requirements for each Paediatric Service Capability level, located in the operational checklists commencing on page 30.

An appropriately trained workforce is critical in ensuring a child safe and child friendly environment. It is recommended that:

Staff members involved in the care of children have training that enables them to recognise and meet the healthcare needs of children. This includes ongoing training in the recognition of the sick and deteriorating child and the provision of paediatric emergency care

Registered nurses (RNs) with skills in caring for children are on-site 24 hours. The RNs are responsible, either directly or in a supervisory role, for the nursing care of all children in their area of work

All triage nurses in EDs are trained and competent in triaging children

Allied Health staff are available to provide services for children

Senior medical professionals with evidence of training and currency of skills in caring for children, including volume of surgery on children undertaken by general and General Practitioner surgeons, and granted an appropriate scope of clinical practice

Directors of Emergency Medicine or their delegate are ultimately responsible for the provision of services to children in the ED. In all facilities with an emergency medicine service a doctor with skills in assessing and managing children with acute problems or paediatrician is available (on site or on-call) for immediate consultation of acutely unwell children on a 24 hourly basis. For service capability level 4 Paediatric Medical services and higher it is expected that a doctor with skills in assessing and managing children with acute problems is on site 24 hours a day, 7 days a week

Other medical specialists may be involved in consulting roles, depending on the level of service provided by the hospital as per the NSW Health Guide to the Role Delineation of Clinical Services (2016).

4.3.4 Operational considerations including safety, guidelines and equipment

Children who present to NSW Health facilities require levels of care and management that address their specific healthcare needs. Reasonable steps should be taken to ensure that:

Children are not placed at risk of harm (including exposure to disturbing sights and sounds) from other patients, staff or visitors

Children are not accommodated with adult patients or share toilet and/or bathroom facilities

Staff members adhere to relevant child protection policies and legislation

Where children are acutely unwell, consultation with a specialist children’s hospital and the Newborn and paediatric Emergency Transport Service (NETS), or relevant interstate service provider, is sought at the earliest opportunity to support availability of transfer services as required. Where possible, access to cameras and/or video conferencing is available to support this process. For more information about escalation processes for acutely unwell children in NSW, refer to NSW Health PD2013_049 Recognition and management of patients who are clinically deteriorating

Paediatric clinical practice guidelines covering the assessment and treatment of specific paediatric conditions are available in areas where care for children is provided. These guidelines have the agreement of both the ED and the paediatric department. For more information about paediatric guidelines refer to http://www.health.nsw.gov.au/kidsfamilies

Children and adolescents are cared for using equipment that is specifically designed to meet their needs, size and developmental age.

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4.4 Service Scope While the NSW Health Guide to Role Delineation of Clinical Services (2016) recognises that minimum core clinical services may be provided through a network, this Framework refers to an assessed service capability level that is operational all of the time:

Services cannot be a Level X MINUS i.e. provide most of the services, or provide some services some of the time

Services can be a Level X PLUS i.e. provides all the services outlined in the service scope for their assessed service capability level PLUS some clinical complexity normally undertaken at a higher level provided a robust risk assessment has been undertaken and these services are consistently available at the facility

4.4.1 Changing Service Capability Levels

Changing service capability levels requires careful planning with respect to operational and clinical risk and the consistency of safe and efficient service delivery. The table below summarises the most common circumstances under which facilities need to change service capability levels. In all circumstances requiring change, LHDs should refer to the NSW Health Guide to Role Delineation of Clinical Services (2016). Due to changes from the 2002 Role Delineation Guide each facility needs to evaluate their role delineation level in line with the current definitions:

Identified Need Service Characteristics Key Considerations

To provide services routinely undertaken at a higher service capability level

Facilities have the clinical expertise, support services and equipment to provide some (but not all) activity described as being within the service scope of a higher level service capability.

Undertaking a higher level service should only be considered where the facility is able to consistently undertake the higher level clinical complexity and a comprehensive risk assessment has been undertaken.

To enable short term changes to a service capability level

A paediatric service may temporarily need to change to a lower service capability level in response to local circumstances.

LHDs are responsible for informing their local paediatric network of these changes and ensuring that appropriate arrangements and management plans are in place. For paediatric services which regularly move to a lower service capability level, the LHD or facility should review the capability of that service using this Framework.

Permanently moving to a higher service capability level

A facility is able to consistently undertake all the services described for the higher level and has undertaken a risk assessment process. The overall impact of these increased capabilities on clinical outcomes and daily operations has been considered.

Raising the capability level of a service should not occur solely based on the skills of an individual clinician. Any changes need to take into account the required clinical expertise (and the ongoing availability of that clinical expertise), support clinical services and equipment to maintain clinical activity at the proposed higher service capability level.

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4.5 Risk Assessment As per NSW Health Policy Directive PD 2015_043 Risk Management - Enterprise-Wide Risk Management Policy and Framework, risks and being risk aware are an integral part of organisational operations and must be identified and managed at the appropriate level for an organisation to be effective. Opportunities and threats should be addressed through a risk management process in order to maintain and improve performance and achieve identified objectives.

Each paediatric service requires robust clinical and operational risk assessment and referral pathways to accommodate the specific clinical conditions or circumstances for children. Where minimum requirements for a particular service level are unable to be met, timely risk management strategies should be developed, and endorsed by executive leadership with mitigating risk strategies implemented to ensure delivery of safe and sustainable health care. Children should also be individually assessed at each contact for risk factors to ensure that the service has the capability to meet the clinical needs of the child.

Clinical and operational risk assessment applies throughout the care continuum:

At the commencement of care

During an episode of care

During preparation for transfer or discharge

At transfer or discharge.

Clinical risk management is central to ensuring safe paediatric service provision. NSW Health Policy Directive PD2013_049 Recognition and Management of Patients who are Clinically Deteriorating provides LHDs with an additional resource from which to incorporate the policy and standards of the NSW Patient Safety and Clinical Quality Program and the underlying principles of risk management as defined in the AS/NZS ISO 31000:2009 Risk Management – Principles and Guidelines.

As per NSW Health Policy Directive PD2013_049 Recognition and Management of Patients who are Clinically Deteriorating, when a child is deteriorating one or more of the following three steps are required:

Step 1: Facility specific escalation to the most senior expert available

Step 2: Consultation with the LHD’s designated service capability level 4/5 paediatric service

Step 3: Consultation with a children’s hospital, with referral to Newborn and paediatric Emergency Transport Service (NETS), or relevant interstate service provider, for advice, clinical coordination and inter-hospital transfer as appropriate.

See Diagram 4 (page 21) for a graphic representation of the escalation process for a deteriorating child.

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5. A Networked Approach to Paediatric Care

5.1 LHD Approach to Local Networked Paediatric Care Cohesion of the network of paediatric acute care services within a LHD drive the escalation and de-escalation of individual care requirements within a quality and safety environment. As a result, coordinated patient flow between various facilities throughout the course of a child’s hospitalisation maximises LHD resource capacity whilst also delivering appropriate care as close to home as possible. This local networked approach to paediatric acute care service delivery, the core component of this Framework illustrated in diagram 2, also recognises that paediatric healthcare operates in collaboration with, and is reliant upon, a range of other services to provide comprehensive and integrated care to children.

Diagram 3: A tiered networked approach to enabling right care, right place, right time in paediatric healthcare services across NSW

This Framework details planning for clinical complexity and scope of care at individual facilities. LHD paediatric networks provide a structure and system for consultation, escalation and/or transfer of patients to the appropriate level of care based on their individual clinical need facilitating the right care in the right place at the right time. The characteristics of effective LHD paediatric networks include:

Clearly defined and documented pathways and processes for consultation, escalation of care and/or transfer including clinicians in lower level services knowing their networked higher level services, and being confident in contacting those services when consultation, escalation and/or transfer is required

Service capability Levels 4 and 5 paediatric services provide leadership and support of other paediatric services within their own LHD. This includes:

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o Providing clinical advice, support and guidance

o Accepting transfers of children assessed as requiring higher level services

o Developing and maintaining a strong relationship with LHD networked services

o Supporting and participating in training and education

o Participating in clinical review activities such as morbidity and mortality reviews

o Advising on equipment as required

o Providing outreach services (face to face and/or virtual)

Strong relationships between clinicians and services in the local paediatric network including shared understanding of the service capabilities of facilities

A shared care approach between higher level and lower level services

Clear processes for communication and referral so that each service is used appropriately and to its full capability

Opportunities for clinicians to meet and review the effectiveness of, and undertake planning, for the local paediatric network

Whole of local network approach to development of policy and procedures, guidelines, service planning and review

Strong links between maternity and neonatal services clinicians which may include the joint development of guidelines, regular meetings and case discussions

Systems for joint care planning and sharing of information about care

Access to non-emergency transport for transfer to higher level services and return transfers

Identified referral pathways for children to access specialist services, either within the LHD of residence or in another LHD/SHN.

5.2 Role of Children’s Healthcare Network and Clinician Peer Groups Paediatric service capability is supported by the state-wide NSW Children’s Healthcare Network (CHN) which is operationally divided into three geographic regions (Northern, Western, Southern) encompassing metropolitan and rural LHDs.

The role of the CHN is to facilitate engagement and networking between clinicians responsible for delivering acute healthcare to children with the aim of:

Progressing a shared approach to service development

Promoting local innovation

Developing and maintaining staff skills

Promoting standardisation of care and reduction of unwarranted variation

Supporting networking and partnerships between clinicians and services

Creating links with the children’s hospitals for specialist expertise and support.

Clinician peer groups also exist to provide networking opportunities and peer support for paediatric clinicians. The Metropolitan Paediatric Level 4 Units (MP4KIDS) is a clinical network representing paediatric clinicians in public hospitals in metropolitan and outer metropolitan Sydney. Regional Paediatrics NSW (RPNSW) is a clinical network for paediatric clinicians employed in public hospitals in regional NSW. The Paediatric Clinical Nurse Consultants in each LHD are a source of advocacy, education, clinical expertise and collaboration. In addition, each of the CHN regions has a coordinator, a medical lead and an allied health educator. The CHN and related peer-groups serve as a resource for supporting consultation and engagement, and in implementation of the Framework.

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5.3 Consultation, Escalation and/or Transfer All services are required to have Clinical Emergency Response Systems (CERS) to respond to a deteriorating patient consistent with NSW Health Policy Directive PD2013_049 Recognition and Management of Patients who are Clinically Deteriorating.

Each hospital will have local processes for consultation, escalation and/or transfer that reflect:

Service capability

Locally available support services

Access to higher level services within the LHD paediatric network

Geography (e.g. proximity to state borders).

Clinicians in each hospital need to be aware of and use the local escalation process for paediatric care. Diagram 4 illustrates the escalation process when a child requires referral or a higher level of care than is available locally. Telehealth should be used where available, as per the Agency for Clinical Innovation (ACI) Guidelines for the use of Telehealth for Clinical and Non Clinical Settings in NSW. Tool 4 in the companion toolkit provides a checklist for facilities to assess local implementation of escalation process.

Care “close to home” is a critical factor in the management plan for paediatric patients who require their care to be transferred to a higher or lower level service and during discharge planning. Management plans should be jointly developed and shared between the lower level service and the higher level service to ensure a clear and consistent approach to delivering care as close to home as possible.

When a child has been identified as requiring consultation, escalation and/or transfer to higher level services, clinicians should follow the local escalation process which may include contacting:

A hospital in the local LHD network with a medical or surgical service capability level appropriate to the paediatric patient’s assessed needs and/or

The linked tertiary hospital in the local LHD network and/or

The Newborn and paediatric Emergency Transport Service (NETS) on 1300 36 2500 or other relevant interstate service provider for border LHDs.

For those LHDs in state border areas where paediatric transfer is required the escalation process may include an interstate service. In this case, the referral hospital may be the equivalent to a service capability level 4, 5 or 6 paediatric service depending upon the complexity of the child’s needs.

In situations where child abuse or sexual assault is suspected or proven, clinicians must use the Mandatory Reporter’s Guide and contact local child protection services as per local protocols, as specified in NSW Health Policy Directive PD2013_007 Child Wellbeing and Child Protection Policies and Procedures for NSW Health. Clinicians should also apply their local protocols for support and advice. Additional advice is available via the Child Abuse and Sexual Assault Clinical Advice Line (CASACAL). CASACAL provides expert clinical advice by telephone 24/7 for medical forensic examinations.

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Diagram 4: Escalation Process for the Deteriorating Child

5.3.1 Paediatric Patient and Family Escalation of Care

From a quality and safety perspective there are also occasions when the safest system response is to directly empower families to escalate care or initiate specialist consultation. The NSW Clinical Excellence Commission (CEC) leads the REACH (Recognise, Engage, Act, Call, Help is on the way) program for parent/carer initiated urgent responses. This program aligns with National Safety and Quality Health Service Standard (Standard 9.9) which enables patients, families and carers to initiate an escalation of care response.

It is recommended that LHDs also support and empower parents/carers to seek consultation with a paediatrician for a child under the care of a non-paediatric clinician. Tool 5 in the companion toolkit outlines a process for providing parents/carers with the ability to initiate referral to a paediatrician.

5.3.2 Non-Medical Health Professional Escalation of Care

There are many potential situations that could and should provide opportunities for the early involvement of paediatricians within an LHD in the care of children admitted to NSW hospitals under a non-paediatric clinical team. Referrals to a medical specialist are traditionally made from one medical officer to another. The proposed process outlined in Tool 5: Involvement of paediatricians in the care of children in NSW hospitals provides nurses and other non-medical health professionals with the ability to initiate referral to a paediatrician.

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5.3.3 Mental Health Consultation, Escalation and/or Transfer

When a clinician requires either a mental health consultation for a paediatric patient, or to escalate and/or transfer a paediatric patient who is not actively engaged with a mental health service provider, the local escalation process may include:

Contacting the local mental health service, mental health facility or local mental health access line

Contacting the NSW Mental Health Line which operates 24 hours a day on 1800 011 511 (or other relevant advice line in border LHDs).

The NSW Health Policy Directive PD2011-016 Children and Adolescents with Mental Health Problems Requiring Inpatient Care defines the key principles and provides a framework for the most appropriate treatment facility when inpatient treatment is needed. Tool 7: Children and adolescents in paediatric services requiring mental health care covers the key features of this policy.

5.3.4 Decisions about the need for Transfer

Where expert opinions vary regarding patient transfer, the final decision concerning the need for transfer should be made by the local clinician after consultation with a specialist in the higher level service in the LHD and the receiving medical or surgical consultant, with medical retrieval consultant (NETS or relevant interstate service provider) involvement in critical cases.

Where there are unresolved issues, discussion with the relevant LHD Executive should occur.

5.3.5 Vulnerable Children and Families

Paediatric services play an important role in identifying vulnerable families that have complex needs based on their individual circumstances, life history and/or personal vulnerabilities which are likely to require specialist and intensive support from a number of services. These may include current or history of domestic and family violence, child protection issues, substance use, unmanaged or acute mental health issues or primary homelessness. LHDs are required to have local processes in place for consultation and referral where appropriate to ensure families have timely access to support and interventions as needed. The NSW Health Child Wellbeing Units 1300 480 420 can provide support and assistance in determining the level of risk of harm. See NSW Health Policy Directive PD2013-007 Child Wellbeing and Child Protection Policies and Procedures for NSW Health for further information.

5.4 Rural and Remote Considerations Local LHD paediatric networks are expected to support rural and remote facilities. Clinicians in rural and remote facilities need to balance local service capability against the impact of transfer to a higher level service on the child and family. There may be occasions where a family may be unable or unwilling to access the recommended care due to the impact of transfer including travel (logistics and cost) and isolation from family and support.

Where a procedure is identified as an ongoing local need, the LHD should undertake a risk assessment process to assess capability to undertake the procedure locally on an ongoing basis. On an as needed basis, facilities may provide for a higher level of care than their planned service capability level. To ensure clinical safety and quality of care in these instances:

Advice and support should be sought from higher level paediatric services within the local LHD network regarding the child’s clinical management plan

Local consultation should occur with other clinicians and service managers regarding the proposed procedure and impact on related services within the hospital

Detailed discussion should occur with the family regarding any potential risks to the child so that the family is able to make an informed choice regarding decisions for care. This discussion should be documented in the child’s medical record.

Telehealth is widely used across NSW and has the capacity to enable and support the provision of a diverse range of activities across Tiered Networks as outlined in the Guidelines for the use of Telehealth for Clinical and Non Clinical Settings in NSW. These activities, for paediatric patients, include:

Consultation on time-critical treatment (e.g. in the paediatric ward)

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Scheduled clinical care (e.g. specialist clinics)

Education and training of clinicians (including case discussions, debriefs and grand rounds)

Engagement in safety and quality activities (including mortality and morbidity meetings, policy meetings and clinical case reviews)

Communication between a parent/carer and the care team if the parent/carer is separated from the child due to geographic distance or for other reasons.

Access to accommodation can be an issue for families where transfer for more specialised paediatric care is required. Accommodation should be discussed and taken into consideration in determining the transfer destination or return transfer to a hospital close to home.

6. Consumer Perspectives

It is a fundamental principle of paediatric healthcare that the concerns of parents/carers are considered and acted upon. This is enshrined in NSW paediatric clinical practice guidelines, all of which state that parental anxiety should not be discounted as it is often of significance, even if the child does not appear especially unwell.

In line with this principle, consumers should be informed about local paediatric service capability and consumer-based information should be used to manage expectations for care should complications arise and transfer to specialised care outside of the local paediatric service is required. In these instances, clinicians should discuss the recommended plan for care with the family/carer including why there may be a need to transfer to a higher level service.

Families/carers should also be advised that once the higher level of care is no longer required, the child will be transferred back to a hospital with the capability to provide appropriate ongoing care as close to home as possible where appropriate. Feedback regarding services should be sought directly from children and young people, as well as their families and acted upon to improve service delivery.

7. Conclusion

The key driver for the introduction of the NSW Paediatric Service Capability Framework is the need for high quality, safe paediatric services that can be accessed locally, whether in rural and regional locations or in metropolitan locations. Its use will enable Local Health District planning, effective patient care, efficient use of resources, and consistency of paediatric services and surgery for children across the state. The Framework is a key enabler in providing better local care for children, in conjunction with other standards and services for children and families.

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Glossary

Adolescent area is an area for care of adolescent patients in a paediatric ward which is physically appropriate, including consulting and examination areas which enable privacy and confidentiality and age-appropriate rest and meal times; cohorts adolescents together; provides suitable recreation facilities and educational access Care planning refers to the process that enables high quality safe care to be delivered during scheduled (planned) and unscheduled (unplanned, urgent, emergency) patient presentations Catchment for lower level services refers to the LHD determined geographical area for which a level 4 or 5 paediatric medicine service provides support, advice and a point of escalation to levels 2 and 3 services for a paediatric population Clinical Emergency Response System (CERS) is a formalised system for obtaining urgent assistance when a patient is clinically deteriorating including escalation of clinical concern to a Clinical Review (a patient review undertaken within 30 minutes) or a Rapid Response (urgent review) Community services provide support to sustain and nurture the functioning of individuals, families and groups, to maximise their potential and to enhance community wellbeing (Australian Council of Social Service 2009) Evidence check rapid review is a rapid review of existing research and evidence tailored to a policy agency’s individual need Facility includes hospital, Multi-purpose Service and community health centre Multi-Purpose Services are facilities in small rural communities that integrate State and Commonwealth funded health services and programs including acute care, subacute care, residential aged care, emergency, allied health, oral health, primary care and community services Newborn and paediatric Emergency Transport Service (NETS) is a 24/7 state-wide service of NSW Health that provides: expert clinical advice, clinical co-ordination, stabilisation, and emergency treatment and inter-hospital retrieval for sick neonates and children up to the age of 16 years Outreach models including telehealth and outreach clinics describe regular outreach clinics in outer metropolitan, rural and remote regions attended by visiting specialists from metropolitan tertiary paediatric centres, which provide planned care and up-skilling for local health professionals Paediatrician is a Fellow of the Royal Australian College of Physicians and/or other specialist recognition as approved in the Staff Specialists [State] Award and/or who is a specialist as defined in the Health Insurance Act 1973 (Commonwealth). Paediatric close observation is undertaken within dedicated paediatric wards and involves a higher level of monitoring and observation for individual patients who are vulnerable to critical illness compared to standard ward-based care Paediatric medicine is defined as the field of medicine that is concerned with the health of infants, children, and adolescents; their growth and development; and their opportunity to achieve full potential as adults

Paediatric safe area is defined as an area in a hospital where children can be separated from adult patients whilst still being easily observed by appropriately trained nursing staff. This area is:

Protected from the disturbing sights and sounds of adult patients;

Physically safe (any potentially dangerous equipment, medications or fluids are out of reach and/or stored in locked cupboards);

Contains suitable furniture that meets Australasian Health Facility Guidelines;

Provides access to facilities that allow parent/carer to stay with their child during the hospital stay;

Does not require children to pass through an adult ward or area to access facilities and adult patients do not have to pass through areas that accommodate children to reach their own facilities.

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Paediatric safe bed is a bed that can be located anywhere within a facility (including ED, Imaging or a general ward) that meets the criteria for ensuring the safety of the child Paediatric short-stay services describe a model of care that supports the appropriate flow of patients to prevent unnecessary in-patient admissions. This in turn speeds up the admission process for patients who require admission, thereby reducing ED waiting times. Such units use specialist paediatric staff and guidelines for scaling-up Parent/carer refers to the parent/s or person living with the child and assuming legal responsibility for, and providing direct care. This includes birth parent, step-parent, foster parent, legal guardian, custodial parent or safe and appropriate primary care giver Primary care is generally the first point of contact people have with the health system. It relates to the treatment of non-admitted patients in the community Role delineation is a process which describes support services, staffing, minimum safety standards and other requirements to ensure that clinical services are provided safely and are appropriately supported. The NSW Health Guide to Role Delineation of Clinical Services (2016) provides service planners with an agreed (and consistent) language to describe the health facilities and services in the LHD and is one of the tools used in services planning and development. The Guide is not a tool for determining staffing profiles or mandating resource requirements, models of care or clinical practice protocols. It is a descriptive tool to provide advice and promote consistency regarding appropriate support services for the provision of clinical services Telehealth is defined as the secure transmission of images, voice and data between two or more units via telecommunication channels to provide clinical advice, consultation, monitoring, education and training and administrative services Transition care describes the approach to supporting young people with chronic conditions as they move to adult healthcare, including joint paediatric/adult clinics, preparation for transition and integrated psychosocial support

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References

Australian and New Zealand College of Anaesthetists (ANZCA) www.anzca.edu.au/resources/professional-documents/pdfs/ps09-2014-guidelines-on-sedation-and-or-analgesia-for-diagnostic-and-interventionalmedical-dental-or-surgical-procedures.pdf

ANZCA PS29 (2008) Statement on Anaesthesia Care of Children in Healthcare Facilities without Dedicated Paediatric Facilities www.anzca.edu.au/resources/professional-documents/pdfs/ps29-2008-statement-onanaesthesia-care-of-children-in-healthcare-facilities-without-dedicated-paediatric-facilities.pdf

Agency for Clinical Innovation Telehealth Guidelines https://www.aci.health.nsw.gov.au/__data/assets/pdf_file/0010/258706/ACI-telehealth-guidelines.pdf

Department of Premier and Cabinet, Final Report of the Special Commission of Inquiry: Acute Care Services in NSW Public Hospitals http://www.dpc.nsw.gov.au/__data/assets/pdf_file/0003/34194/Overview_-_Special_Commission_Of_Inquiry_Into_Acute_Care_Services_In_New_South_Wales_Public_Hospitals.pdf

NSW Excellence and Innovation in Healthcare Health Pathways Implementation and Evaluation www.eih.health.nsw.gov.au/initiatives/health-pathways-implementation-and-evaluation

NSW Health Guide to the Role Delineation of Health Services (2002) http://www.health.nsw.gov.au/services/publications/guide-role-delineation-health-services.pdf

NSW Health Guide to the Role Delineation of Clinical Services (2016) www.health.nsw.gov.au/services/Publications/role-delineation-of-clinical-services.PDF

NSW Health PD2010_030 Critical Care Tertiary Referral Networks (Paediatrics) www.health.nsw.gov.au/policies/pd/2010/pdf/PD2010_030.pdf

NSW Health PD2010_031 Children and Adolescents - Inter-Facility Transfers www.health.nsw.gov.au/policies/pd/2010/pdf/PD2010_031.pdf

NSW Health PD2010_032 Children and Adolescents - Admission to Services Designated Level 1-3 Paediatric Medicine & Surgery www.health.nsw.gov.au/policies/pd/2010/pdf/PD2010_032.pdf

NSW Health PD2010_033 Children and Adolescents - Safety and Security in NSW Acute Health Facilities www.health.nsw.gov.au/policies/pd/2010/pdf/PD2010_033.pdf

NSW Health PD2010_034 Children and Adolescents - Guidelines for Care in Acute Care Settings www.health.nsw.gov.au/policies/pd/2010/PD2010_034.html

NSW Health PD2011_016 Children and Adolescents with Mental Health Problems Requiring Inpatient Care www.health.nsw.gov.au/policies/pd/2011/pdf/PD2011_016.pdf

NSW Health PD2011_038 Children and Infants - Recognition of a Sick Baby or Child in the Emergency Department www.health.nsw.gov.au/policies/pd/2011/pdf/PD2011_038.pdf

NSW Health PD2013_007 Child Wellbeing and Child Protection Policies and Procedures for NSW Health www.health.nsw.gov.au/policies/pd/2013/pdf/PD2013_007.pdf

NSW Health PD2013_049 Recognition and Management of Patients who are Clinically Deteriorating www.health.nsw.gov.au/policies/pd/2013/pdf/PD2013_049.pdf

NSW Health PD2014_025 Departure of Emergency Department Patients www.health.nsw.gov.au/policies/pd/2014/pdf/PD2014_025.pdf

NSW Health PD2015_043 Risk Management - Enterprise-Wide Risk Management Policy and Framework - NSW Health www.health.nsw.gov.au/policies/pd/2015/pdf/PD2015_043.pdf

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NSW Health PD2016_018 NSW Maternity and Neonatal Service Capability Framework www.health.nsw.gov.au/policies/gl/2016/pdf/GL2016_018.pdf

NSW Health Surgery for Children in Metropolitan Sydney Strategic Framework http://www.health.nsw.gov.au/kidsfamilies/paediatric/Publications/surgery-for-children-framework.pdf

NSW State Health Plan Towards 2021 www.health.nsw.gov.au/statehealthplan

NSQHS Standards www.safetyandquality.gov.au/our-work/accreditation-and-the-nsqhs-standards/

Paediatric medicine (definition of) www.medicinenet.com

Sax Institute Variation in Paediatric Clinical Practice http://www.saxinstitute.org.au/wp-content/uploads/PAEDIATRIC-CLINICAL-VARIATION-ECHECK.pdf

Sax Institute Paediatric Services Capacity http://www.saxinstitute.org.au/wp-content/uploads/Paediatric-services-capacity.pdf

Standards Australia AS/NZS ISO 31000:2009 Risk Management – Principles and Guidelines

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Appendix 1 - Key Interfaces in the Delivery and Further Development of

NSW Paediatric Service Capability

This Framework focuses on capabilities required to deliver high quality safe paediatric acute care services for children aged 0-16 years. Beyond the scope of this Framework, six critical clinical interfaces were identified as being essential in providing a comprehensive picture of healthcare services for children. The elements of these six interfaces are described below:

Maternity and Neonatal Services

The GL2016_018 Maternity and Neonatal Service Capability Framework describes the level of planned activity and clinical complexity that a hospital is capable of safely providing. Facilities must, at a minimum, be capable of providing all the planned clinical services described for their service level. All maternity facilities have a linked neonatal service. It is acknowledged that paediatricians provide supervision and or specialist care in neonatal services from Level 2 as per the NSW Health Guide to the Role Delineation of Clinical Services.

Child and Family Health Services

Child and family health services in general relate to services that are provided in the community setting. Child and family health services tend to have a preventive or early intervention focus for the whole early childhood population (children aged 0–5 years), with links to more targeted interventions and programs for those children and families requiring additional health and wellbeing services. There are also child and family health services that focus on specific population groups.

Services available to support children and their families include early childhood health, allied health, general practitioners, day stay and residential care centres, perinatal mental health and other specialist services, including parenting programs or services for parents facing particular risks or challenges that may impact on their ability to effectively care for their children.

Early childhood health centres provide a free service for all parents in NSW. Early childhood health centres are staffed by child and family health nurses who offer health, development and wellbeing checks for every child, according to the minimum schedule of health checks outlined in the child Personal Health Record (Blue Book). Each child born in NSW provided is provided with a Blue Book. They also provide support, education and information on all aspects of parenting.

Further information can be found at: http://www.health.nsw.gov.au/kidsfamilies/pages/default.aspx.

Mental Health Services for Children and Young People

Child and Adolescent Mental Health Services are specialist community and inpatient mental health services for children and adolescents up to the age of 18 years. Opportunities for collaboration between paediatric services and Child and Adolescent Mental Health Services are recognised as critical to appropriate management of patients and their families. The policy PD2011_016 Children and Adolescents with Mental Health Problems Requiring Inpatient Care defines the key principles for determining the most appropriate treatment hospital when inpatient care is required.

A dedicated mental health project is being undertaken within the NSW Ministry of Health’s Whole of Health Program. The Mental Health Project Lead is providing strategic assistance to LHDs, SHNs and other key stakeholders to improve access to care for Mental Health consumers across the whole patient journey. A specific focus in the project is on children, young people and families, to establish a “whole of hospital/whole of mental health service response”. Further information about the project can be found at www.health.nsw.gov.au/wohp.

A training and resources package Young People in Paediatric Settings has been developed and is currently being implemented through the Health Education & Training Institute.

NSW Paediatric Service Capability Framework NSW Health 29

Primary Care Services for Children

Primary care is the first level of contact individuals, families and communities have with the health care system. Primary care services encompass services provided by GPs, child and family health services and allied health professionals. These services provide screening, immunisation, assessment and treatment for physical and mental health issues. Paediatric services support primary care services through assessment and/or treatment of children referred by primary care clinicians and the provision of outreach services. Integration of care is a key direction in the future of service delivery with opportunities for greater connectivity of care between primary care services, local paediatric services (secondary) and/or specialist children’s hospitals (tertiary). This includes relationships to support access by primary care clinicians, children and their families to paediatric advice as needed especially for chronic/complex conditions. Primary Health Networks are important LHD partners in progressing integrated care, with the HealthPathways initiative a current example of this collaboration where the ongoing pursuit of paediatric applications are progressing.

Transition to Adult Services

Increasing numbers of young people with chronic conditions arising in childhood are surviving into adulthood, with more young people transitioning from paediatric services to mainstream adult services. Appropriate transition pathways and processes can positively impact on the young person’s ability to manage their health. The NSW Agency for Clinical Innovation Transition Care Network (Network) works to improve the experience and delivery of healthcare for young people with chronic health problems and disabilities as well as provide guidance to facilitate their effective transition from paediatric to adult health care. The Network has developed principles and resources to support transition. Trapeze is a service of the Sydney Children’s Hospitals Network which provides support for current and former patients in the transition to adult services with particular emphasis on developing links with a GP or appropriate other healthcare providers, care coordination and navigating the health system.

Cross Border Flows and Issues

Border LHDs use interstate services. The most significant outflows are from Murrumbidgee LHD to Victoria, from Southern NSW LHD to the ACT, from Northern NSW LHD to Queensland and from Far West LHD to South Australia, resulting in some LHDs having relatively lower rates of self-sufficiency. Such patterns may affect not only the non-tertiary but also the tertiary flow of activity, involving interstate children’s hospitals. Border LHDs also access interstate neonatal and paediatric transport services and local escalation processes should be in place in facilities to reflect the specific pathways for care in their border areas.

NSW Paediatric Service Capability Framework NSW Health 30

Appendix 2 - Paediatric Service Capability Operational Level Checklists

This section guides LHDs and paediatric services in determining clinical activity for all service capability levels of paediatric services up to level 5 based on their service’s capability level. This section also references the minimum core service requirements outlined in the NSW Health Guide to the Role Delineation of Clinical Services (2016).

These checklists should be used by lead clinicians and managers responsible for the provision of paediatric services and in consultation with the LHD’s Clinical (Medical) Lead of Paediatric Services and a health service planner. Using the operational checklists below to assess the existing paediatric service (e.g. ED, short-stay service, acute review service, outpatient clinics and inpatient units), local action is required to undertake a self-assessment to identify the strengths and/or opportunities in relation to the determined paediatric service capability level.

A service needs to meet all requirements to qualify for a specific service capability level. Gaps in service level capabilities should be addressed locally as part of clinical and capital services action planning including a reassignment of role levels and networking as appropriate. Tools in the companion toolkit are identified in the checklists where relevant.

In addition to the annual review of role delineation by health service planners these service capability levels should be reviewed on a three-yearly basis with clinical service plans and when there are significant changes in the caseload, casemix, models of care or resources available.

Self-Assessment Summary for Paediatric Service Capability Please use this page to record self-assessment process and authorisation in conjunction with one or more of the paediatric medicine and/or paediatric surgery checklists on the following pages. ___________________________________________________________________________________

NSW Paediatric Service Capability Framework NSW Health 31

Summary of Service Capability

Site

Date of assessment

Clinical or Operational risks identified (Y/N)

Identified risks added to the organisation’s risk register

Summary of Actions Planned

Agreed level of paediatric medical service

Network Level 4/5 paediatric medical service (or SLA with equivalent service in another jurisdiction):

Participants involved

Paediatric Nurse Unit Manager /Nurse Manager

Medical lead of Paediatrics

Health Service Planner

Agreed level of surgical service for children

Network level 4 surgical service for children (or SLA with equivalent service in another jurisdiction):

Participants involved

Paediatric Nurse Unit Manager /Nurse Manager

Surgeon

Anaesthetist

Medical lead of Paediatrics

Health Service Planner

Planned date of next review

Endorsements

LHD Clinical (Medical) Lead of Paediatric Services

Name Date Signature

Director of Clinical Operations

Name Date Signature

Chief Executive Officer

Name Date Signature

No Planned Service (NPS) ___________________________________________________________________________________

NSW Paediatric Service Capability Framework NSW Health 32

SERVICE SCOPE

Requirements met

YES NO

IN PROGRESS

Enter expected date for

completion

No planned service for children ☐ ☐

For emergency presentations provides care according to the Emergency Medicine Service Standard (see the NSW Health Guide to Role Delineation of Clinical Services (2016))

☐ ☐

Capabilities

For emergency presentations:

Provides emergency care for children ☐ ☐

Escalates to higher level service when additional care or admission is

required

Minimum Core Service Requirements

Anaesthetics - ☐ ☐

Operating Suite - ☐ ☐

Close Observation Unit - ☐ ☐

Intensive Care Service - ☐ ☐

Nuclear Medicine - ☐ ☐

Radiology - ☐ ☐

Pathology - ☐ ☐

Pharmacy - ☐ ☐

Service Requirements

For emergency presentations:

Formal network with Level 4 or higher level paediatric medical and surgical services in the LHD including 24 hour access to specialist support services and advice

☐ ☐

Documented processes for consultation, escalation and patient transfer is organised with networked paediatric service and statewide paediatric services, including NETS and Ambulance Service NSW (or relevant interstate service provider)

☐ ☐

Availability of appropriate equipment for children (including resuscitation) ☐ ☐

Workforce with appropriate skills to care for paediatric patients, including competence in recognising and managing deterioration and resuscitation of infants and children

☐ ☐

Processes for RNs with advanced training (e.g. First Line Emergency Care Course) in rural and remote facilities to implement more advanced interventions in line with the NSW Rural Paediatric Emergency Clinical Guidelines

☐ ☐

Capability to identify and respond to children at risk of harm and those who have suffered alleged physical and/or sexual abuse or neglect

☐ ☐

Identified Clinical (Medical) Lead of Paediatric Service in the LHD to support clinical care of paediatric patients

☐ ☐

Capacity to provide a paediatric Safe Bed Refer to Tool 6: Requirements for Child Friendly and Child Safe Health Facilities

☐ ☐

Level 2 Paediatric Medicine Service

All capability requirements in the checklist below are needed for an individual service to operate as a Level 2 Paediatric Medicine Service. ___________________________________________________________________________________

NSW Paediatric Service Capability Framework NSW Health 33

SERVICE SCOPE

Requirements met

YES NO

IN PROGRESS

Enter expected date for

completion

For children presenting to emergency provides care according to the Emergency Medicine Service Standard

☐ ☐

May hold patients for observation or admit for up to 48 hours in consultation with a paediatrician in the LHD local network within 24 hours of presenting

☐ ☐

Capabilities

Escalates care to higher level service

When additional care is required, or in response to signs of clinical deterioration

☐ ☐

Minimum Core Service Requirements (may be networked)

Anaesthetics Level 1 ☐ ☐

Operating Suite Level 1 ☐ ☐

Close Observation Unit - ☐ ☐

Intensive Care Service - ☐ ☐

Nuclear Medicine - ☐ ☐

Radiology Level 1 ☐ ☐

Pathology Level 1 ☐ ☐

Pharmacy Level 1 ☐ ☐

IF NO TO ANY OF THESE REQUIREMENTS, THE SERVICE DOES NOT MEET A LEVEL 2 PAEDIATRIC MEDICINE SERVICE.

Service Requirements

Capacity to provide a paediatric safe bed. See Tool 6 Requirements for Child Friendly and Child Safe Health Facilities

☐ ☐

Formal network and relationship with level 4 or higher level service within LHD including 24 hour access to a paediatrician for support and advice. Refer to PD2013_049 and Tool 5: Involvement of paediatricians in the care of children in NSW hospitals

☐ ☐

Clinicians with skills in caring for paediatric patients, including competence in recognising and managing deterioration and resuscitation of infants and children

Access to Allied Health services and Community Health services as required

☐ ☐

☐ ☐

Appropriate medication and drug dose resources for children

Appropriate equipment for children (including resuscitation) available

☐ ☐

☐ ☐

Access to paediatric clinical practice guidelines (e.g. http://www.health.nsw.gov.au/kidsfamilies/)

☐ ☐

Quality and Safety Patient safety and quality incidents are recognised, reported and analysed by

the multidisciplinary team and this information is used to improve safety improve safety

☐ ☐

Meets National Safety and Quality Health Service (NSQHS) standards

http://www.safetyandquality.gov.au/ from a paediatric perspective

☐ ☐

Level 2 Paediatric Medicine Service

All capability requirements in the checklist below are needed for an individual service to operate as a Level 2 Paediatric Medicine Service. ___________________________________________________________________________________

NSW Paediatric Service Capability Framework NSW Health 34

CLINICAL GOVERNANCE

Requirements met

YES NO

IN PROGRESS

Enter expected date for

completion

Guidance for service provision

Documented local guidelines/protocols:

Scope and level of complexity of patients who may be admitted ☐ ☐

Criteria for early consultation with a paediatrician. Refer to Tool 5 Involvement of paediatricians in the care of children in NSW hospitals

☐ ☐

Mechanisms in place for short-term follow-up of children

☐ ☐

Identifying children and families at risk, including risk of harm and those who have suffered alleged physical and/or sexual abuse or neglect and facilitating access to appropriate agencies or support services

☐ ☐

Referral pathways to relevant support, programs and services for vulnerable

populations e.g. from culturally and linguistically diverse (CALD) background

☐ ☐

Referral pathways to relevant Aboriginal support, programs and services ☐ ☐

Consumer information on service capability

☐ ☐

Scope of practice Processes to ensure clinical staff have skills in caring for paediatric patients and work within their scope of practice

☐ ☐

Processes for RNs with advanced training (e.g. First Line Emergency Care Course) in rural and remote facilities to implement more advanced interventions in line with the NSW Rural Paediatric Emergency Clinical Guidelines

☐ ☐

Consultation, escalation and transfer

Clinical Emergency Response Systems (CERS) for recognition of, and response to, paediatric clinical deterioration are in place as per PD2013_049 – Refer to checklist in Tool 4: Self-assessment of paediatric clinical emergency response system and beyond facility escalation process

☐ ☐

Consultation, escalation and patient transfer is organised with networked paediatric service and statewide paediatric services, including NETS and Ambulance Service NSW (or relevant interstate service provider)

☐ ☐

Access to cameras and/or videoconferencing to support assessment and consultation

☐ ☐

Education Access to paediatric training which is available on HETI on-line

http://www.heti.nsw.gov.au/

☐ ☐

Level 2 Surgery for Children Service

All capability requirements in the checklist below are needed for an individual service to operate as a Level 2 Surgery for Children Service. ___________________________________________________________________________________

NSW Paediatric Service Capability Framework NSW Health 35

SERVICE SCOPE

Requirements met

YES NO

IN PROGRESS

Enter expected date for

completion

For children presenting to emergency provides care according to the Emergency Medicine Service Standard Refer to Tool 3: Emergency surgery for children: self-assessment to support implementation of LHD designated surgical sites and the Surgery of Children in Metropolitan Sydney emergency department algorithm

☐ ☐

Provides emergency procedures for children with a life-threatening condition in consultation with a Level 4 or higher surgical service for children

☐ ☐

No planned surgical service for children

☐ ☐

Capabilities

Escalates care to higher level service When admission for surgical care is required, or in response to signs of clinical deterioration

☐ ☐

Minimum Core Service Requirements (May be networked)

Anaesthetics Level 1 ☐ ☐

Operating Suite Level 1 ☐ ☐

Close Observation Unit - ☐ ☐

Intensive Care Service - ☐ ☐

Nuclear Medicine - ☐ ☐

Radiology Level 1 ☐ ☐

Pathology Level 1 ☐ ☐

Pharmacy Level 1 ☐ ☐

IF NO TO ANY OF THESE REQUIREMENTS, THE SERVICE DOES NOT MEET A LEVEL 2 SURGERY FOR CHILDREN SERVICE.

Service Requirements

Level 2 or higher paediatric medicine service available in the hospital, or risk assessment to ensure appropriate pre- and post-operative care

☐ ☐

Formal network and relationship with level 4 or higher level service within LHD including 24 hour access to paediatric medical and surgical support and advice – Refer to PD2013_049 and Tool 5: Involvement of paediatricians in the care of children in NSW hospitals

☐ ☐

Capacity to provide a paediatric safe bed. See Tool 6 Requirements for Child Friendly and Child Safe Health Facilities ☐ ☐

Clinicians with skills in caring for paediatric patients, including competence in recognising and managing deterioration and resuscitation of infants and children ☐ ☐

Access to Allied Health services and Community Health services as required ☐ ☐

Appropriate medication and drug dose resources for children ☐ ☐

Appropriate equipment for children (including resuscitation) available ☐ ☐

Access to paediatric clinical practice guidelines (e.g. http://www.health.nsw.gov.au/kidsfamilies/)

☐ ☐

Quality and Safety Patient safety and quality incidents are recognised, reported and analysed by

the multidisciplinary team and this information is used to improve safety

☐ ☐

Meets National Safety and Quality Health Service (NSQHS) standards

http://www.safetyandquality.gov.au/ from a paediatric perspective ☐ ☐

Level 2 Surgery for Children Service

All capability requirements in the checklist below are needed for an individual service to operate as a Level 2 Surgery for Children Service. ___________________________________________________________________________________

NSW Paediatric Service Capability Framework NSW Health 36

CLINICAL GOVERNANCE

Requirements met

YES NO

IN PROGRESS

Enter expected date for

completion

Guidance for service provision

Documented local guidelines/protocols:

Scope and level of complexity of patients who may be admitted ☐ ☐

Mechanisms in place for short-term follow-up of children ☐ ☐

Identifying children and families at risk, including risk of harm and those who have suffered alleged physical and/or sexual abuse or neglect and facilitating access to appropriate agencies or support services

☐ ☐

Referral pathways to relevant support, programs and services for vulnerable populations e.g. from culturally and linguistically diverse (CALD) background

☐ ☐

Referral pathways to relevant Aboriginal support, programs and services ☐ ☐

Consumer information on service capability ☐ ☐

Scope of practice Processes to ensure clinical staff have skills in caring for paediatric patients and

work within their scope of practice ☐ ☐

Processes for RNs with advanced training e.g. First Line Emergency Care Course Paediatric Advanced Clinical Nurses, in rural and remote facilities to implement more advanced interventions in line with the NSW Rural Paediatric Emergency Clinical Guidelines

☐ ☐

Consultation, escalation and transfer

Clinical Emergency Response Systems (CERS) for recognition of, and response to, paediatric clinical deterioration are in place as per PD2013_049 – Refer to checklist in Tool 4: Self-assessment of paediatric clinical emergency response system and beyond facility escalation process

☐ ☐

Consultation, escalation and patient transfer is organised with networked paediatric service and statewide paediatric services, including NETS and Ambulance Service NSW (or relevant interstate service provider)

☐ ☐

Access to cameras and/or videoconferencing to support assessment and consultation

☐ ☐

Education Access to paediatric training which is available on HETI on-line

http://www.heti.nsw.gov.au/

☐ ☐

Level 3 Paediatric Medicine Service

All capability requirements in the checklist below are needed for an individual service to operate as a Level 3 Paediatric Medicine Service. ___________________________________________________________________________________

NSW Paediatric Service Capability Framework NSW Health 37

SERVICE SCOPE

Requirements met

YES NO

IN PROGRESS

Enter expected date for

completion

Provide inpatient care in a paediatric safe bed for common paediatric medical conditions (according to clinical judgement) in consultation with a paediatrician in the LHD local network within 24 hours of presentation.

☐ ☐

Consideration of models of care that provide an alternative to an overnight admission e.g. ambulatory care; short stay; acute review services; hospital in the home - Refer to Tool 1: Requirements for establishment and operation of paediatric short stay and acute review services

☐ ☐

Capabilities

Escalates care to higher level service When additional care that cannot be provided in the hospital is required, or in response to signs of clinical deterioration

☐ ☐

Minimum Core Service Requirements (may be networked)

Anaesthetics Level 3 ☐ ☐

Operating Suite Level 3 ☐ ☐

Close Observation Unit - ☐ ☐

Intensive Care Service - ☐ ☐

Nuclear Medicine - ☐ ☐

Radiology Level 3 ☐ ☐

Pathology Level 3 ☐ ☐

Pharmacy Level 3 ☐ ☐

IF NO TO ANY OF THESE REQUIREMENTS, THE SERVICE DOES NOT MEET A LEVEL 3 PAEDIATRIC MEDICINE SERVICE.

Service Requirements

Capacity to provide a paediatric safe bed and area/ward. See Tool 6 Requirements for Child Friendly and Child Safe Health Facilities

☐ ☐

Formal network and relationship with level 4 or higher level service within LHD including 24 hour access to paediatrician support and advice – Refer to PD2013_049 and Tool 5: Involvement of paediatricians in the care of children in NSW hospitals

☐ ☐

Medical officer with skills in the assessment of management of children with acute medical problems available 24 hours to provide paediatric care for overnight admitted patients (may be on call)

☐ ☐

Ability to provide close observation in paediatric inpatient ward - Refer to Tool 2: Requirements for close observation capability in paediatric wards

☐ ☐

Clinicians with skills in caring for paediatric patients, including competence in recognising and managing deterioration and advanced resuscitation of infants and children

☐ ☐

Access to allied health services and community health services as required ☐ ☐

Appropriate equipment for children (including resuscitation) available ☐ ☐

Appropriate medication and drug dose resources for children ☐ ☐

Access to paediatric clinical practice guidelines (e.g. http://www.health.nsw.gov.au/kidsfamilies/ )

☐ ☐

Quality and Safety Patient safety and quality incidents are recognised, reported and analysed by

the multidisciplinary team and this information is used to improve safety ☐ ☐

Meets National Safety and Quality Health Service (NSQHS) standards

(http://www.safetyandquality.gov.au ) from a paediatric perspective ☐ ☐

Level 3 Paediatric Medicine Service

All capability requirements in the checklist below are needed for an individual service to operate as a Level 3 Paediatric Medicine Service. ___________________________________________________________________________________

NSW Paediatric Service Capability Framework NSW Health 38

CLINICAL GOVERNANCE

Requirements met

YES NO

IN PROGRESS

Enter expected date for

completion

Guidance for service provision Documented local guideline/protocol for:

Scope and level of complexity of patients who may be admitted to the service

☐ ☐

Mechanisms in place for short-term follow-up of children ☐ ☐

Identifying children and families at risk, including risk of harm and those who have suffered alleged physical and/or sexual abuse or neglect and facilitating access to appropriate agencies or support services

☐ ☐

Referral pathways to relevant support, programs and services for

vulnerable populations e.g. from culturally and linguistically diverse (CALD) background

☐ ☐

Referral pathways to relevant Aboriginal support, programs and

services ☐ ☐

Consumer information on service capability ☐ ☐

Scope of practice Processes to ensure clinical staff have skills in caring for

paediatric patients and work within their scope of practice ☐ ☐

Processes for RNs with advanced training (e.g. First Line Emergency Care Course) in rural and remote facilities to implement more advanced interventions in line with the NSW Rural Paediatric Emergency Clinical Guidelines

☐ ☐

Consultation, escalation and transfer

Clinical Emergency Response Systems (CERS) for recognition of, and response to, paediatric clinical deterioration as per PD2013_049 – Refer to checklist in Tool 4: Self-assessment of paediatric clinical emergency response system and beyond facility escalation process

☐ ☐

Consultation, escalation and patient transfer is organised with networked paediatric service and statewide paediatric services, including NETS and Ambulance Service NSW (or relevant interstate service provider)

☐ ☐

Access to cameras and/or videoconferencing to support assessment and consultation

☐ ☐

Education Access to paediatric training which is available on HETI on-line http://www.heti.nsw.gov.au/

☐ ☐

Level 3 Surgery for Children Service

All capability requirements in the checklist below are needed for an individual service to operate as a Level 3 Surgery for Children Service. ___________________________________________________________________________________

NSW Paediatric Service Capability Framework NSW Health 39

SERVICE SCOPE

Requirements met

YES NO

IN PROGRESS

Enter expected date for

completion

Provide Minor* surgical procedures on ASA category 1 to 4 ̂children. ☐ ☐

Provide Common and Intermediate*, and selected Major* surgical procedures on ASA category 1 and 2 ̂children (see Appendix 3 and Appendix 4 for definitions for Minor; Common and Intermediate; Major surgery and ASA category 1 to 4^) Refer to Tool 3: Emergency surgery for children: self-assessment to support implementation of LHD designated surgical sites and the emergency department algorithm

☐ ☐

Consideration of models of care that provide an alternative to an in-patient admission e.g. ambulatory care; short stay; acute review services; hospital in the home – Refer to Tool 1: Requirements for establishment and operation of paediatric short stay and acute review services

☐ ☐

Capabilities

Escalates care to higher level service When additional care that cannot be provided in the hospital is required, or in response to signs of clinical deterioration

☐ ☐

Minimum Core Service Requirements (May be networked)

Anaesthetics Level 3 ☐ ☐

Operating Suite Level 3 ☐ ☐

Close Observation Unit - ☐ ☐

Intensive Care Service - ☐ ☐

Nuclear Medicine - ☐ ☐

Radiology Level 3 ☐ ☐

Pathology Level 3 ☐ ☐

Pharmacy Level 3 ☐ ☐

IF NO TO ANY OF THESE REQUIREMENTS, THE SERVICE DOES NOT MEET A LEVEL 3 SURGERY FOR CHILDREN SERVICE.

Service Requirements

Level 3 or higher paediatric medicine service available in the hospital, or risk assessment to ensure appropriate pre- and post-operative care

☐ ☐

Process for involvement of paediatricians in the care of children admitted under a surgeon. Refer to tool 5: Involvement of Paediatricians in the Care of Children in NSW Hospitals

☐ ☐

Capacity to provide a paediatric safe bed and area/ward. See tool 6 Requirements for Child Friendly and Child Safe Health Facilities

☐ ☐

Formal network and relationship with level 4 or higher level service within LHD including 24 hour access to paediatric medical and surgical support and advice – Refer to PD2013_049 and Tool 5: Involvement of paediatricians in the care of children in NSW hospitals

☐ ☐

Ability to provide close observation in paediatric inpatient ward where applicable - Refer to Tool 2: Requirements for close observation capability in paediatric wards

☐ ☐

Medical officer with skills in the assessment of management of children with acute medical problems available 24 hours to provide paediatric care for overnight admitted patients (may be on call)

☐ ☐

Clinicians with skills in caring for paediatric patients, including competence in recognising and managing deterioration and advanced resuscitation of infants and children

☐ ☐

Access to Allied Health services and Community Health services as required ☐ ☐

Appropriate equipment for children (including resuscitation) available ☐ ☐

Appropriate medication and drug dose resources for children ☐ ☐

Access to paediatric clinical practice guidelines (e.g. http://www.health.nsw.gov.au/kidsfamilies/)

☐ ☐

Level 3 Surgery for Children Service

All capability requirements in the checklist below are needed for an individual service to operate as a Level 3 Surgery for Children Service. ___________________________________________________________________________________

NSW Paediatric Service Capability Framework NSW Health 40

Operating suite and recovery space appropriate to the special needs of children and carers – see Tool 6: Requirements for Child Friendly and Child Safe Health Facilities

☐ ☐

Appropriate positioning, mobility and/or pressure relieving equipment for children available for use in the postoperative period and/or at discharge

☐ ☐

Quality and Safety Patient safety and quality incidents are recognised, reported and analysed by

the multidisciplinary team and this information is used to improve safety ☐ ☐

Meets National Safety and Quality Health Service (NSQHS) standards http://www.safetyandquality.gov.au/ from a paediatric perspective

☐ ☐

CLINICAL GOVERNANCE

Requirements met

YES NO

IN PROGRESS

Enter expected date for

completion

Guidance for service provision

Documented local guideline/protocol for:

Scope and level of complexity of patients who may be admitted to the service ☐ ☐

Mechanisms in place for short-term surgical follow-up of children ☐ ☐

Identifying children and families at risk, including risk of harm and those who

have suffered alleged physical and/or sexual abuse or neglect and facilitating access to appropriate agencies or support services

☐ ☐

Referral pathways to relevant support, programs and services for vulnerable

populations e.g. from culturally and linguistically diverse (CALD) background ☐ ☐

Referral pathways to relevant Aboriginal support, programs and services ☐ ☐

Consumer information on service capability ☐ ☐

Scope of practice Surgeon or medical practitioner (surgery) skilled in treating children and

undertaking sufficient volume of surgery for safe practice ☐ ☐

Anaesthetist or medical practitioner (anaesthesia) skilled in treating children ☐ ☐

Processes to ensure clinical staff have skills in caring for paediatric patients and

work within their scope of practice ☐ ☐

Process for RNs with advanced training e.g. First Line Emergency Care Course Paediatric Advanced Clinical Nurses, in rural and remote facilities to implement more advanced interventions in line with the NSW Rural Paediatric Emergency Clinical Guidelines

☐ ☐

Consultation, escalation and transfer

Clinical Emergency Response Systems (CERS) for recognition of, and response to, paediatric clinical deterioration as per PD2013_049 – Refer to checklist in Tool 4: Self-assessment of paediatric clinical emergency response system and beyond facility escalation process

☐ ☐

Consultation, escalation and patient transfer is organised with networked

paediatric service and statewide paediatric services, including NETS and Ambulance Service NSW (or relevant interstate service provider)

☐ ☐

Access to cameras and/or videoconferencing to support assessment and

consultation ☐ ☐

Education Access to paediatric training which is available on HETI on-line http://www.heti.nsw.gov.au/

☐ ☐

Level 4 Paediatric Medicine Service

All capability requirements in the checklist below are needed for an individual service to operate as a Level 4 Paediatric Medicine Service. ___________________________________________________________________________________

NSW Paediatric Service Capability Framework NSW Health 41

SERVICE SCOPE

Requirements met

YES NO

IN PROGRESS

Enter expected date for

completion

Provides inpatient services lead by paediatricians ☐ ☐

Provides non-inpatient child and family health services (e.g. developmental assessment, multidisciplinary assessment and treatment of psychosocial and behavioural problems)

☐ ☐

Provides one or more of the following: ambulatory care services, short stay and/or acute review service, paediatric hospital in the home service Refer to Tool 1: Requirements for establishment and operation of paediatric short stay and acute review services

☐ ☐

Undertakes an active program of undergraduate and postgraduate teaching and research coordinated with a Level 6 service

☐ ☐

Capabilities

Escalates care to tertiary level service

When additional care that cannot be provided in the hospital is required, or in response to signs of clinical deterioration, beyond the capacity of the service Return transfer of patients from specialist children’s hospital

☐ ☐

Minimum Core Service Requirements (may be networked)

Anaesthetics Level 4 ☐ ☐

Operating Suite Level 4 ☐ ☐

Close Observation Unit - ☐ ☐

Intensive Care Service - ☐ ☐

Nuclear Medicine Level 4 ☐ ☐

Radiology Level 4 ☐ ☐

Pathology Level 4 ☐ ☐

Pharmacy Level 4 ☐ ☐

IF NO TO ANY OF THESE REQUIREMENTS, THE SERVICE DOES NOT MEET A LEVEL 4 PAEDIATRIC MEDICINE SERVICE.

Service Requirements

Clinical Lead of service and 24/7 roster of paediatricians - Refer to Tool 5: Involvement of paediatricians in the care of children in NSW hospitals

☐ ☐

Provides paediatric support to their catchment lower level services within the LHD – Refer to Tool 5: Involvement of paediatricians in the care of children in NSW hospitals

☐ ☐

Dedicated paediatric ward including ability to isolate in a single room Refer to Tool 6: Requirements for child friendly and child safe health facilities

☐ ☐

Ability to provide close observation in paediatric inpatient ward - Refer to Tool 2: Requirements for close observation capability in paediatric wards

☐ ☐

Clinicians with skills in caring for paediatric patients, including competence in recognising and managing deterioration and advanced resuscitation of infants and children

☐ ☐

Appropriate junior medical staff on-site 24/7 with skills in caring for paediatric patients, including competence in recognising and managing deterioration and advanced resuscitation of infants and children

☐ ☐

Appropriate equipment for children (including resuscitation) available ☐ ☐

Appropriate medication and drug dose resources for children ☐ ☐

Access to adult specialty services ☐ ☐

Access to child and youth mental health services ☐ ☐

Should have adolescent area available ☐ ☐

Allied health professionals with specific paediatric caseload on-site (e.g. occupational therapist, physiotherapist, speech pathologist, dietician and/or social worker). Access to child life therapy/resources

☐ ☐

Access to youth health services and transition services for chronic illness ☐ ☐

Level 4 Paediatric Medicine Service

All capability requirements in the checklist below are needed for an individual service to operate as a Level 4 Paediatric Medicine Service. ___________________________________________________________________________________

NSW Paediatric Service Capability Framework NSW Health 42

Quality and Safety Patient safety and quality incidents are recognised, reported and analysed by

the multidisciplinary team and this information is used to improve safety

☐ ☐

Meets National Safety and Quality Health Service (NSQHS) standards http://www.safetyandquality.gov.au/ from a paediatric perspective ☐ ☐

Participates in clinical safety and quality processes of lower level sites in LHD ☐ ☐

CLINICAL GOVERNANCE

Requirements met

YES NO

IN PROGRESS

Enter expected date for

completion

Guidance for service provision

Documented local guideline/protocol for:

Scope and level of complexity of patients who may be admitted to the service ☐ ☐

Mechanisms in place for short-term follow-up of children ☐ ☐

Identifying children and families at risk, including risk of harm and those who

have suffered alleged physical and/or sexual abuse or neglect and facilitating access to appropriate agencies or support services

☐ ☐

Referral pathways to relevant support, programs and services for vulnerable populations e.g. from culturally and linguistically diverse (CALD) background

☐ ☐

Referral pathways to relevant Aboriginal support, programs and services ☐ ☐

Consumer information on service capability ☐ ☐

Scope of practice Processes to ensure clinical staff have skills in caring for paediatric patients and

work within their scope of practice ☐ ☐

Consultation, escalation and transfer

Clinical Emergency Response Systems (CERS) for recognition of, and response to, paediatric clinical deterioration as per PD2013_049 – Refer to checklist in Tool 4: Self-assessment of paediatric clinical emergency response system and beyond facility escalation process

☐ ☐

Consultation, escalation and patient transfer is organised with networked

paediatric service and statewide paediatric services, including NETS and Ambulance Service NSW (or relevant interstate service provider)

☐ ☐

Access to cameras and/or videoconferencing to support assessment and

consultation ☐ ☐

Education Access to paediatric training which is available on HETI on-line

http://www.heti.nsw.gov.au/ ☐ ☐

Level 4 Surgery for Children Service

All capability requirements in the checklist below are needed for an individual service to operate as a Level 4 Surgery for Children Service starting with Service Scope and concluding with Child Friendly and child safe environments. ___________________________________________________________________________________

NSW Paediatric Service Capability Framework NSW Health 43

SERVICE SCOPE

Requirements met

YES NO

IN PROGRESS

Enter expected date for

completion

Provide Common and Intermediate*, and selected Major* surgical procedures on ASA category 1 to 4 children (Appendix 4) Refer to Tool 3: Emergency surgery for children: self-assessment to support implementation of LHD designated surgical sites and the emergency department algorithm

☐ ☐

Provides one or more of the following: ambulatory care; short stay; acute review services; hospital in the home Refer to Tool 1: Requirements for establishment and operation of paediatric short stay and acute review services

☐ ☐

Capabilities

Escalates care to tertiary level service

When additional care that cannot be provided in the hospital is required, or in response to signs of clinical deterioration, beyond the capacity of the service

☐ ☐

Minimum Core Service Requirements (May be networked)

Anaesthetics Level 4 ☐ ☐

Operating Suite Level 4 ☐ ☐

Close Observation Unit - ☐ ☐

Intensive Care Service - ☐ ☐

Nuclear Medicine Level 4 ☐ ☐

Radiology Level 4 ☐ ☐

Pathology Level 4 ☐ ☐

Pharmacy Level 4 ☐ ☐

IF NO TO ANY OF THESE REQUIREMENTS, THE SERVICE DOES NOT MEET A LEVEL 4 SURGERY FOR CHILDREN SERVICE.

Service Requirements

Level 4 or higher paediatric medicine service available in the hospital with paediatrician available 24 hours - Refer to Tool 5: Involvement of paediatricians in the care of children in NSW hospitals

☐ ☐

Process for involvement of paediatricians in the care of children admitted under a surgeon. Refer to Tool 5: Involvement of Paediatricians in the Care of Children in NSW Hospitals

☐ ☐

Provides support to their catchment lower level services within the LHD ☐ ☐

Dedicated paediatric ward including ability to isolate in a single room Refer to Tool 6 Requirements for child friendly and child safe health facilities

☐ ☐

Ability to provide close observation in paediatric inpatient ward - Refer to Tool 2: Requirements for close observation capability in paediatric wards

☐ ☐

Clinicians with skills in caring for paediatric patients and competent in recognising and managing deterioration and advanced resuscitation of infants and children

☐ ☐

Appropriate junior medical staff on-site 24/7 with skills in caring for paediatric patients, including competence in recognising and managing deterioration and advanced resuscitation of infants and children

☐ ☐

Appropriate equipment for children (including resuscitation) available ☐ ☐

Appropriate medication and drug dose resources for children ☐ ☐

Access to adult specialty services ☐ ☐

Should have adolescent area available ☐ ☐

Allied health professionals with specific paediatric caseload on-site (e.g. occupational therapist, physiotherapist, speech pathologist, dietician and/or social worker). Access to child life therapy/resources

☐ ☐

Level 4 Surgery for Children Service

All capability requirements in the checklist below are needed for an individual service to operate as a Level 4 Surgery for Children Service starting with Service Scope and concluding with Child Friendly and child safe environments. ___________________________________________________________________________________

NSW Paediatric Service Capability Framework NSW Health 44

Operating suite and recovery space appropriate to the special needs of children and carers – refer to Tool 6 Requirements for child friendly and child safe health facilities

☐ ☐

Appropriate positioning, mobility and/or pressure relieving equipment for children available for use in the postoperative period and/or at discharge

☐ ☐

Access to paediatric clinical practice guidelines (e.g. http://www.health.nsw.gov.au/kidsfamilies )

☐ ☐

Quality and Safety

Patient safety and quality incidents are recognised, reported and analysed by the multidisciplinary team and this information is used to improve safety

☐ ☐

Meets National Safety and Quality Health Service (NSQHS) standards http://www.safetyandquality.gov.au/ from a paediatric perspective ☐ ☐

Participates in clinical safety and quality processes of lower level sites in LHD ☐ ☐

CLINICAL GOVERNANCE

Requirements met

YES NO

IN PROGRESS

Enter expected date for

completion

Guidance for service provision

Documented local guideline/protocol for:

Scope and level of complexity of patients who may be admitted to the service ☐ ☐

Mechanisms in place for short-term surgical follow-up of children ☐ ☐

Identifying children and families at risk, including risk of harm and those who

have suffered alleged physical and/or sexual abuse or neglect and facilitating access to appropriate agencies or support services

☐ ☐

Referral pathways to relevant support, programs and services for vulnerable

populations e.g. from culturally and linguistically diverse (CALD) background ☐ ☐

Referral pathways to relevant Aboriginal support, programs and services ☐ ☐

Consumer information on service capability ☐ ☐

Scope of practice Surgeon skilled in treating children and undertaking sufficient volume of surgery

for safe practice ☐ ☐

Anaesthetist skilled in treating children ☐ ☐

Processes to ensure clinical staff have skills in caring for paediatric patients and

work within their scope of practice ☐ ☐

Consultation, escalation and transfer

Clinical Emergency Response Systems (CERS) for recognition of, and response to, paediatric clinical deterioration as per PD2013_049 – Refer to checklist in Tool 4: Self-assessment of paediatric clinical emergency response system and beyond facility escalation process

☐ ☐

Consultation, escalation and patient transfer is organised with networked

paediatric service and statewide paediatric services, including NETS and Ambulance Service NSW (or relevant interstate service provider)

☐ ☐

Access to cameras and/or videoconferencing is required to support assessment

and consultation regarding children who are acutely unwell or deteriorating ☐ ☐

Education Access to paediatric training which is available on HETI on-line

http://www.heti.nsw.gov.au/ ☐ ☐

Level 5 Paediatric Medicine Service

All capability requirements in the checklist below are needed for an individual service to operate as a Level 5 Paediatric Medicine Service. ___________________________________________________________________________________

NSW Paediatric Service Capability Framework NSW Health 45

SERVICE SCOPE

Requirements met

YES NO

IN PROGRESS

Enter expected date for

completion

Provides inpatient service lead by paediatricians and one or more paediatric specialty services ☐ ☐

Provides non-inpatient child and family health services (e.g. developmental assessment, multidisciplinary assessment and treatment of psychosocial and behavioural problems)

☐ ☐

Provides one or more of the following: ambulatory care services, short stay and/or acute review service, paediatric hospital in the home service Refer to Tool 1: Requirements for establishment and operation of paediatric short stay and acute review services

☐ ☐

Undertakes an active program of undergraduate and postgraduate teaching and research coordinated with a Level 6 service

☐ ☐

Capabilities

Escalates care to tertiary level service When additional care that cannot be provided in the hospital is required, or in response to signs of clinical deterioration, beyond the capacity of the service Return transfer of patients from specialist children’s hospital

☐ ☐

Minimum Core Service Requirements (May be networked)

Anaesthetics Level 5 ☐ ☐

Operating Suite Level 5 ☐ ☐

Close Observation Unit - ☐ ☐

Intensive Care Service Level 5 ☐ ☐

Nuclear Medicine Level 5 ☐ ☐

Radiology Level 5 ☐ ☐

Pathology Level 5 ☐ ☐

Pharmacy Level 5 ☐ ☐

IF NO TO ANY OF THESE REQUIREMENTS, THE SERVICE DOES NOT MEET A LEVEL 5 PAEDIATRIC MEDICINE SERVICE.

Service Requirements

Clinical Lead of service and 24/7 roster of paediatricians– Refer to Tool 5: Involvement of paediatricians in the care of children in NSW hospitals

☐ ☐

Provides paediatric support to lower level services within the LHD - Refer to PD2013_049 and Tool 5: Involvement of paediatricians in the care of children in NSW hospitals

☐ ☐

Dedicated paediatric ward Refer to Tool 6: Requirements for child friendly and child safe health facilities

☐ ☐

Clinicians with skills in caring for paediatric patients, including competence in recognising and managing deterioration and advanced resuscitation of infants and children

☐ ☐

Ability to provide close observation in paediatric inpatient ward - Refer to Tool 2: Requirements for close observation capability in paediatric wards

☐ ☐

Appropriate junior medical staff on-site 24/7 with skills in caring for paediatric patients, including competence in recognising and managing deterioration and advanced resuscitation of infants and children

☐ ☐

Preferably, medical officer in paediatrics with three or more postgraduate years of experience on-site 24 hours; may be in training with the Royal Australasian College of Physicians (RACP)

☐ ☐

Appropriate equipment for children (including resuscitation) available ☐ ☐

Appropriate medication and drug dose resources for children ☐ ☐

Community paediatrician available ☐ ☐

Allied health professionals with specific paediatric caseload on-site (e.g. occupational therapist, physiotherapist, speech pathologist, dietician and/or social worker). Access to child life therapy/ resources

☐ ☐

Access to adult specialty services ☐ ☐

Adolescent area available ☐ ☐

Access to youth health services, such as adolescent clinics and/or transition ☐ ☐

Level 5 Paediatric Medicine Service

All capability requirements in the checklist below are needed for an individual service to operate as a Level 5 Paediatric Medicine Service. ___________________________________________________________________________________

NSW Paediatric Service Capability Framework NSW Health 46

Access to child and youth mental health services ☐ ☐

May have school service for inpatients provided by the Department of Education ☐ ☐

Access to paediatric clinical practice guidelines (e.g. http://www.health.nsw.gov.au/kidsfamilies)

☐ ☐

Quality and Safety

Patient safety and quality incidents are recognised, reported and analysed by the multidisciplinary team and this information is used to improve safety ☐ ☐

Meets National Safety and Quality Health Service (NSQHS) standards http://www.safetyandquality.gov.au from a paediatric perspective ☐ ☐

Participates in clinical safety and quality processes of lower level sites in LHD ☐ ☐

CLINICAL GOVERNANCE

Requirements met

YES NO

IN PROGRESS

Enter expected date for

completion

Guidance for service provision

Documented local guideline/protocol for:

Scope and level of complexity of patients who may be admitted to the service ☐ ☐

Mechanisms in place for short-term follow-up of children ☐ ☐

Identifying children and families at risk, including risk of harm and those who

have suffered alleged physical and/or sexual abuse or neglect and facilitating access to appropriate agencies or support services

☐ ☐

Referral pathways to relevant support, programs and services for vulnerable

populations e.g. from culturally and linguistically diverse (CALD) background ☐ ☐

Referral pathways to relevant Aboriginal support, programs and services ☐ ☐

Consumer information on service capability ☐ ☐

Scope of practice Processes to ensure clinical staff have skills in caring for paediatric patients and

work within their scope of practice

☐ ☐

Consultation, escalation and transfer

Clinical Emergency Response Systems (CERS) for recognition of, and response to, paediatric clinical deterioration as per PD2013_049 – Refer to checklist in Tool 4: Self-assessment of paediatric clinical emergency response system and beyond facility escalation process

☐ ☐

Consultation, escalation and patient transfer is organised with networked

paediatric service and statewide paediatric services, including NETS and Ambulance Service NSW (or relevant interstate service provider)

☐ ☐

Access to cameras and/or videoconferencing to support assessment and

consultation regarding children who are acutely unwell or deteriorating ☐ ☐

Education Access to paediatric training which is available on HETI on-line

http://www.heti.nsw.gov.au/ ☐ ☐

Note: There is no level 5 Surgery for Children Service in the NSW Health Guide to the Role Delineation of Clinical Services (2016)

NSW Paediatric Service Capability Framework NSW Health 47

Appendix 3 - American Society of Anesthesiologists (ASA) Physical Status

Classification System

https://www.asahq.org/resources/clinical-information/asa-physical-status-classification-system

NSW Paediatric Service Capability Framework NSW Health 48

Appendix 4 - Indicative List of Surgery for Children

There is no widely accepted and validated system for classifying the physiological stressfulness of surgical procedures. The examples given below, drawn from different specialties, are intended to provide an indicative guide only and do not replace clinical judgement. Some procedures commonly provided on an emergency basis are included (e.g. suture of laceration, closed reduction of fracture) as useful general indicators of surgical complexity.

Minor Common and Intermediate

Major Complex Major

Skin biopsy

Skin lesion curettage and cautery

Skin lesion excision

Suture of laceration

Drainage of abscess

Minor debridement

Insertion of grommets

Tooth extraction

Skin excision with flap or graft closure

Laser skin surgery

Appendicectomy

Closed reduction of fracture

Percutaneous wire removal

Simple skin graft

Superficial corneal foreign body removal

Diagnostic endoscopy

Herniotomy

Orchidopexy

Tonsillectomy

Adenoidectomy

Squint surgery

Insertion of central line in first two years of life

Ureteric reimplantation

Urethroplasty

Operative reduction of intussusception

Closure of colostomy

Therapeutic endoscopy

Foot surgery (e.g. tendon release or transfer, subtalar fusion)

Thoracotomy

Splenectomy

Cleft lip/palate surgery

Major reconstructive surgery (e.g. anorectoplasty, rectosigmoidectomy)

Open heart surgery

Organ transplant

Laparoscopic procedures <5 years of age

Neurosurgery

Scoliosis surgery

*Note: The actual range of procedures that may be performed by individual practitioners will be determined through the

credentialling process where clinical privileges/scope of practice is granted.

Reproduced from NSW Health Guide to the Role Delineation of Clinical Services (2016) Appendix II – Indicative List of Surgery for Children