THE COMPLEX CARE HUB AT ROYAL CHILDREN’S HOSPITAL MELBOURNE: A REVISED MODEL OF CARE FOR CHILDREN WITH MEDICAL COMPLEXITY
Grainne Butler, Nicki Mountford, Stephanie McArdle, Susie Gibb, Anita D’Aprano
Children with medical complexity are not always well supported by traditional models of care organised around specialist departments. This patient population continues to increase with advances in medical treatments and increasing survival in childhood from serious illness. At the Royal Children’s Hospital in Melbourne, Australia it was apparent that, despite many excellent and innovative programs, including a 20-year history of care at home for technology dependent children, care for these children was rather fragmented and often crisis driven.
In 2014, in response to the challenges posed, a review was undertaken that considered the perspectives of staff and families along with service utilization and international experience. A new model was developed after a successful pilot and introduced in 2 phases. The Complex Care Hub, the culmination of this process, was launched in July 2017 and now provides support for around 350 of our most complex and fragile patients across 3 tiers of support.
The model is based on a partnership between families and providers and delivers care coordination via a key contact, 24-hour access to clinical advice, proactive care planning, psycho-social support and for the most fragile and intense patients, in home health care support using specifically trained lay support workers.
We describe the service including the mechanisms in place to address equity of access and service provision across this diverse patient group. The measured impacts and the ongoing challenges are outlined.