Outpatients reform in the Child Development Program01March 2012

GP – Specialist Outpatient Project

Project Scope• 2 Year Project (2009 -2010)• Evaluation partner – UQ

Services in scopeRoyal Brisbane & Women’s Hospital• Urology Outpatients• Ophthalmology OutpatientsRoyal Children’s Hospital• Paediatric ENT• Child Development Program

GP – Specialist Outpatient Project

Aim of the project: To assign GPs to work with outpatient services to:• Understand issues faced by staff and specialists in OPD

clinics• Review current referral & discharge processes• Provide a GP perspective on referral and discharge

processes• Collaboratively work toward reducing waiting list. • Achieve better continuity of patient care

Child Development Program

GP Advisor - Dr Dana Newcomb

• Benchmarking nationally with services in Sydney, Melbourne, Perth, Gold Coast and Brisbane.

• Literature review on child development shared care models

• Interviews with senior CDP staff (Brisbane, Gold Coast, Sydney

• Identification of issues contributing to long waiting lists

Issues Identified

• Referral process• Lack of trust/understanding of roles• Internal processes

Referral Process

CDU

GPReferral Required

Other

Teacher

Parent

Assessment of Referrals

GP

Lack of Trust & Understanding of Roles

• Specialists did not discharge patients• Poor communication between specialists and GPs • Generally poor collaboration between CDP and

GPs• Lack of GP knowledge about developmental

disorders• Lack of GP awareness of other community

resource options• Poor collaboration between Community Child

Health Nurses and GPs

Internal Processes

• New patients were required to be seen by the specialist prior to receiving any allied health services.

• Wait times refer to the time waiting to see the specialist.

• Wait times for allied services vary, but generally relatively lengthy.

Development of a GP Liaison Role

GP Liaison Officer - Lesley Martin Work with the GP Advisor to:• Develop protocols which support Shared Care

Model • Define referral guidelines• Maximise use of Information Technology• Identify alternative community resource options• Develop an early identification tool• Collect service utilisation data

Data Collection

Clinical diagnostic data was collected over a three month period to discern the highest primary diagnoses with a view to service planning

1. Austistic Spectrum Disorder 2. Pervasive Developmental Disorder as a

secondary diagnosis 3. Intellectual impairment

50% of referrals in that time related to speech and language concerns of 0-2yr olds.

Outputs, Resources & Tools• The Red Flag Early Intervention Guide for

children 0 – 5 years. • eReferral template developed• Clear referral guidelines published• Centralized referral assessment process• Feedback to GP process introduced• Dedicated GP phone number• Intake officer – alternate options• GP Liaison – 116 GP visits to 47 practices

Outcomes: Referral Process

CDU

Assessment ReportOther

Teacher

Parent

Assessment of Referrals

GP

Outcomes

• GP phone line utilised - 41% of phone calls received were from GPs.

• 96% of GPs Surveyed were positive about the changes

• Waiting times were reduced from over 12 months to 10 weeks

GP Perspective

• Positive feedback from GPs

• Laminated Red Flag Resource displayed in Practices/Treatment rooms

• Practice visits well received

• GP referrals more qualitative and inclusive of pre-determining factors

• Secure messaging - direct referral link to central Clinical Intake at CDP

Paediatric Specialists’ Perspective

• Raised awareness of GP role

• Increased confidence to transfer review patients to GP care

• Letters to GPs have become more structured

• Recognition of enhancements achieved through electronic

communication

• Paediatric representation on Shared Care Working Party

Patient Perspectives

• Improved continuity of care

• Clearer referral pathway

• More timely response to referral and appointment

booking.

• Enhanced transition into adulthood for patients with life-

long complex developmental difficulties

In Summary

• GP input into OPD processes has made a

difference to waiting lists

• Electronic communication between OPD and GP

has streamlined processes

• This project has assisted with ongoing service

planning

For more details......

Helen HoareHealth Service Liaison ManagerMetro North Brisbane Medicare Local

helen.hoare@mnbml.com.au