Same-Day Discharge for Paediatric Uncomplicated Appendicitis in Australia.

Hospital-acquired urinary tract infections (UTIs) have a detrimental effect on patients, families, and hospital resources. The Sydney Children's Hospital Network (SCHN) participates in the NSQIP-Pediatric (NSQIP-P) to monitor postoperative complications. NSQIP-P data revealed that the median UTI rate at SCHN was 1.75% in 2019, 3.5 times higher than the NSQIP-P target rate of 0.5%. Over three quarters of the NSQIP-P identified patients with UTI also had a urinary catheterization performed intraoperatively. A quality improvement project was conducted between mid-2018 and 2021 to minimize catheter-associated UTIs (CAUTIs) at SCHN. NSQIP-P samples include pediatric (younger than 18 years) surgical patients from an 8-day cycle operative log. NSQIP-P data are statistically analyzed by the American College of Surgeons and provide biannual internationally benchmarked reports. The project used clinical redesign methodology with a 6-phase process for quality improvement projects. The objectives of the project were to reduce urinary catheter duration of use, educate parents or carers, and improve catheter care and insertion technique by health staff. The duration of a urinary catheter in situ reduced from a median of 4.5 to 3 days from 2017 to 2021. The median NSQIP-P UTI rate at SCHN was reduced by 47.4% from 1.75% in 2019 to 0.9% in 2022. A multifactorial approach in quality improvement has been shown to be an effective strategy to reduce UTI rates at SCHN, and patient outcomes were improved within a 3-year timeframe. Although this project has reduced UTI rates at SCHN, there remain opportunities for further improvement.

Journal of Paediatrics and Child HealthEarly View Instructive Case Finger tips: A novel approach to managing life-threatening neonatal limb ischaemia Rebecca Barzegar, Corresponding Author Rebecca Barzegar rebecca.barzegar@health.nsw.gov.au orcid.org/0000-0002-0773-3229 Grace Centre for Newborn Intensive Care, The Sydney Children's Hospitals Network Randwick and Westmead, Sydney, New South Wales, Australia Correspondence: Dr Rebecca Barzegar, Grace Centre for Newborn Intensive Care, The Sydney Children's Hospitals Network Randwick and Westmead, Cnr Hawkesbury Road and Hainsworth Street, Westmead, NSW 2145, Australia. Fax: 02 9845 2251; email: rebecca.barzegar@health.nsw.gov.auSearch for more papers by this authorRobert J Halliday, Robert J Halliday Grace Centre for Newborn Care, The Sydney Children's Hospital Network Randwick and Westmead, Sydney, New South Wales, AustraliaSearch for more papers by this authorCatherine Piasini, Catherine Piasini Grace Centre for Newborn Care, The Sydney Children's Hospital Network Randwick and Westmead, Sydney, New South Wales, AustraliaSearch for more papers by this author Rebecca Barzegar, Corresponding Author Rebecca Barzegar rebecca.barzegar@health.nsw.gov.au orcid.org/0000-0002-0773-3229 Grace Centre for Newborn Intensive Care, The Sydney Children's Hospitals Network Randwick and Westmead, Sydney, New South Wales, Australia Correspondence: Dr Rebecca Barzegar, Grace Centre for Newborn Intensive Care, The Sydney Children's Hospitals Network Randwick and Westmead, Cnr Hawkesbury Road and Hainsworth Street, Westmead, NSW 2145, Australia. Fax: 02 9845 2251; email: rebecca.barzegar@health.nsw.gov.auSearch for more papers by this authorRobert J Halliday, Robert J Halliday Grace Centre for Newborn Care, The Sydney Children's Hospital Network Randwick and Westmead, Sydney, New South Wales, AustraliaSearch for more papers by this authorCatherine Piasini, Catherine Piasini Grace Centre for Newborn Care, The Sydney Children's Hospital Network Randwick and Westmead, Sydney, New South Wales, AustraliaSearch for more papers by this author First published: 02 August 2021 https://doi.org/10.1111/jpc.15680 Conflict of interest: None declared. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Early ViewOnline Version of Record before inclusion in an issue RelatedInformation

Acta PaediatricaAccepted Articles BRIEF REPORT National surveillance of severe microcephaly in Australia Carlos Nunez, Corresponding Author Carlos Nunez [email protected] orcid.org/0000-0002-5417-9582 The University of Sydney. Faculty of Medicine and Health, Discipline of Child and Adolescent Health, Sydney, NSW, Australia The Australian Paediatric Surveillance Unit (APSU). Sydney, NSW, Australia Correspondence Dr Carlos Nunez, the Australian Paediatric Surveillance (APSU), Level 2, Kids Research, The Children's Hospital at Westmead, Locked Bag 4001, Westmead NSW 2145, Australia. Email: [email protected]Search for more papers by this authorAnne Morris, Anne Morris The University of Sydney. Faculty of Medicine and Health, Discipline of Child and Adolescent Health, Sydney, NSW, Australia The Australian Paediatric Surveillance Unit (APSU). Sydney, NSW, Australia Kids Research, The Sydney Children's Hospitals Network (Westmead), Sydney, NSW, AustraliaSearch for more papers by this authorElizabeth J. Elliott, Elizabeth J. Elliott The University of Sydney. Faculty of Medicine and Health, Discipline of Child and Adolescent Health, Sydney, NSW, Australia The Australian Paediatric Surveillance Unit (APSU). Sydney, NSW, Australia Kids Research, The Sydney Children's Hospitals Network (Westmead), Sydney, NSW, AustraliaSearch for more papers by this author Carlos Nunez, Corresponding Author Carlos Nunez [email protected] orcid.org/0000-0002-5417-9582 The University of Sydney. Faculty of Medicine and Health, Discipline of Child and Adolescent Health, Sydney, NSW, Australia The Australian Paediatric Surveillance Unit (APSU). Sydney, NSW, Australia Correspondence Dr Carlos Nunez, the Australian Paediatric Surveillance (APSU), Level 2, Kids Research, The Children's Hospital at Westmead, Locked Bag 4001, Westmead NSW 2145, Australia. Email: [email protected]Search for more papers by this authorAnne Morris, Anne Morris The University of Sydney. Faculty of Medicine and Health, Discipline of Child and Adolescent Health, Sydney, NSW, Australia The Australian Paediatric Surveillance Unit (APSU). Sydney, NSW, Australia Kids Research, The Sydney Children's Hospitals Network (Westmead), Sydney, NSW, AustraliaSearch for more papers by this authorElizabeth J. Elliott, Elizabeth J. Elliott The University of Sydney. Faculty of Medicine and Health, Discipline of Child and Adolescent Health, Sydney, NSW, Australia The Australian Paediatric Surveillance Unit (APSU). Sydney, NSW, Australia Kids Research, The Sydney Children's Hospitals Network (Westmead), Sydney, NSW, AustraliaSearch for more papers by this author First published: 14 May 2023 https://doi.org/10.1111/apa.16846 This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi:10.1111/apa.16846. AboutPDF ToolsExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Accepted ArticlesAccepted, unedited articles published online and citable. The final edited and typeset version of record will appear in the future. RelatedInformation

Coronavirus disease 2019 (COVID-19) has resulted in over 2 million deaths globally. The experience in Australia presents an opportunity to study contrasting responses to the COVID-19 health system shock. We adapted the Hanefeld et al framework for health systems shocks to create the COVID-19 System Shock Framework (CSSF). This framework enabled us to assess innovations and changes created through COVID-19 at the Sydney Children's Hospitals Network (SCHN), the largest provider of children's health services in the Southern hemisphere. We used ethnographic methods, guided by the CSSF, to map innovations and initiatives implemented across SCHN during the pandemic. An embedded field researcher shadowed members of the emergency operations centre (EOC) for nine months. We also reviewed clinic and policy documents pertinent to SCHN's response to COVID-19 and conducted interviews and focus groups with stakeholders, including clinical directors, project managers, frontline clinicians, and other personnel involved in implementing innovations across SCHN. The CSSF captured SCHN's complex response to the pandemic. Responses included a COVID-19 assessment clinic, inpatient and infectious disease management services, redeploying and managing a workforce working from home, cohesive communication initiatives, and remote delivery of care, all enabled by a dedicated COVID-19 fund. The health system values that shaped SCHN's response to the pandemic included principles of equity of healthcare delivery, holistic and integrated models of care, and supporting workforce wellbeing. SCHN's resilience was enabled by innovation fostered through a non-hierarchical governance structure and responsiveness to emerging challenges balanced with a singular vision. Using the CSSF, we found that SCHN's ability to innovate was key to ensuring its resilience during the pandemic.

Sydney has a large and highly mobile immigrant community. The pattern of paediatric tuberculosis (TB) disease in this highly cosmopolitan city is not well documented. We reviewed data on all children notified with TB in New South Wales (NSW), Australia, from January 2014 to December 2015, complemented by an expanded dataset for children managed within the Sydney Children's Hospitals Network (SCHN). Over the 2-year study period, 921 TB cases were identified in NSW, including 26 (2.8%) children younger than 15 years of age. Of 23 children and adolescents treated for TB in the SCHN, 21 (91.3%) had a history of recent immigration from, or travel to, a country with high TB incidence, and 7 (30.4%) reported contact with an infectious TB case in Australia. Fourteen (60.9%) children had microbiologically confirmed TB; of these, 5 (21.7%) had acid-fast bacilli on microscopy, 8 (34.8%) were positive by polymerase chain reaction and 11 (47.8%) were positive by culture. All Mycobacterium tuberculosis isolates were susceptible to first-line drugs. Ten (43.5%) cases were not vaccinated with bacille Calmette-Guérin (BCG), including all cases with severe disease: 2 with disseminated (miliary) TB and 3 with tuberculous meningitis. Our findings emphasise the need for improved TB prevention and surveillance in children at high risk of exposure, particularly young children travelling to areas of high TB incidence.

Journal of Paediatrics and Child HealthVolume 52, Issue 3 p. 256-257 Viewpoint Why respecting all human beings' privacy matters Vicki Xafis, Corresponding Author Vicki Xafis vicki.xafis@health.nsw.gov.au Clinical Ethics, Sydney Children's Hospital Network, Westmead, New South Wales,, AustraliaCorrespondence: Dr Vicki Xafis, Clinical Ethics, Children's Hospital at Westmead, Westmead, NSW 2145, Australia. Fax: +61 29845 1007; email: vicki.xafis@health.nsw.gov.auSearch for more papers by this author Vicki Xafis, Corresponding Author Vicki Xafis vicki.xafis@health.nsw.gov.au Clinical Ethics, Sydney Children's Hospital Network, Westmead, New South Wales,, AustraliaCorrespondence: Dr Vicki Xafis, Clinical Ethics, Children's Hospital at Westmead, Westmead, NSW 2145, Australia. Fax: +61 29845 1007; email: vicki.xafis@health.nsw.gov.auSearch for more papers by this author First published: 28 April 2016 https://doi.org/10.1111/jpc.13144Citations: 2Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume52, Issue3March 2016Pages 256-257 RelatedInformation

Background Some of the leading causes of morbidity and mortality for Australian youth arise from modifiable psychosocial concerns. Psychosocial assessment can help identify young people at risk and support actions that protect wellbeing. The gold standard assessment for youth is the HEEADSSS interview. Australian governments recommend the HEEADSSS interview for young people in health settings, but adoption is still in its early stages. Recently, a digital self-assessment version of the HEEADSSS (the e-HEEADSSS) was piloted at the Sydney Children's Hospital Network. A program of research has been established to evaluate outcomes and consider broader implementation. Methods Study 1 involved a retrospective analysis to compare the HEEADSSS interview and the e-HEEADSSS. Documentation from 146 matched records collected at the Sydney Children's Hospital Network were analysed to compare approaches. Study 2 utilised a qualitative design to evaluate patient and staff barriers and facilitators to implementation and scale-up of the e-HEEADSSS. Patients (n = 8) and staff (n = 8) participated in online semi-structured interviews. Results Study 1 found the e-HEEADSSS improves assessment uptake and sensitivity compared to face-to-face interviews and takes less time. Disclosure rates were higher for all psychosocial categories especially in sensitive areas of emotions, drug use, sex, and safety. Study 2 found strong support for the e-HEEADSSS from patients and staff. Key benefits included design, functionality, reduced time, convenience, improved disclosure, perceived privacy, improved fidelity, and reduced stigma. Key challenges were available resources, continuity of staff training, clinical pathways, and risks of off-site completions. Conclusions The e-HEEADSSS shows promise as a psychosocial screening tool to support intervention for young people. More work is required to appropriately scale and sustain implementation of the e-HEEADSSS within the Australian health system. Key messages • Digital psychosocial assessments show promise for supporting the mental and physical health of adolescents and young adults. • Implementation of digital psychosocial assessments within the Australian health system requires considered support.

The Sydney Children's Hospital Network Eating Disorder Service (EDS) at The Children's Hospital at Westmead (CHW) is a tertiary service that offers a range of family focused treatment options for young people with an eating disorder. The Intensive Family and Adolescent Eating Disorder (IFAED) Day Program is a new program that has been operating since September 2014, which targets young people and their families who have not been responding to standard treatment or who present with additional complexity. The IFAED program is designed as a treatment option that is more intensive than outpatient treatment, but less restrictive than overnight inpatient care. It operates five days per week and offers integrative and multidisciplinary care combining medical review, psychological treatment, meal support, secondary education and family support, including multiple family therapy. Theoretically, the program aims to strengthen and support families by increasing treatment intensity and solidarity to address barriers that are preventing progress. Interventions are provided for both families and young people. Underpinning the program is the belief that families are essential to recovery with weekly family therapy and parent groups enabling the family to be more responsive to the young person's behavioural and emotional needs. Group therapy for the young people targets skills to manage distress, improve flexible thinking, explore adolescent issues and improve communication skills. These interventions aim to improve coping and help the family support to be more effective. This presentation will outline the current IFAED Day Program structure and content, theoretical underpinnings and some preliminary outcome data.

BackgroundIn New South Wales serious publicised adverse events in 2006 brought quality and safety to community attention. The Garling external review of 2008 made 139 recommendations, including the creation a...

Introduction : Children are increasingly surviving antenatally with complex and chronic conditions. Their families face significant challenges in navigating the health system, and managing transport, cost, and school and work days missed to access care from the network of tertiary children’s hospitals in NSW - Sydney Children's Hospitals Network. Transformational change is required from this organisation, frequently seen as an ivory tower that isolates children from primary care and local health services. Practice change implemented : Partnerships have been formed with local hospitals and general practitioners, to support an integrated model of care that helps families feel safe wherever they are accessing health services. Care Coordinators are responsible for facilitating shared care models, identifying opportunities to localise care and guiding the child and their family in navigating the health system. The project is using a QI framework, with each of the project streams testing the model of care conducting a series of Plan, Do, Study, Act cycles to refine the model through the experience of each child referred to the program. Aim and theory of change : The aim is for everyone to understand their role in a child’s care plan and feel supported in their work, and for families to feel connected to their local health services. There is emerging evidence that Care Coordination decreases Emergency Department presentations and admissions, and increases parental satisfaction and family functioning. Targeted population and stake holders : The cohorts amongst this population include babies discharged from the neonatal intensive care unit; children with naso-gastric and gastro-jejunal feeding tubes; school children in rural areas; children who present frequently to ED with asthma; and children with food allergies. 160 care professionals have partnered with the Kids GPS initiative, ranging from sub-specialists, paediatricians and nurses, to GPs and Allied Health practitioners in the community. Timeline : The project commenced in 2015 and is currently implementing across three regions. Highlights : Amongst the 190 children enrolled in the Care Coordination service, an estimated 36,500kms in travel and 168 day only admissions have been avoided in the year to June 2016. The program has facilitated GP engagement for more than thirty families who did not have a relationship with a general practitioner when initially enrolled. A parent activation measure is being used to establish a measure of parental satisfaction and empowerment in their involvement in their child’s care. Sustainability : The cultural change, cross-boundary clinical networks and system capacity created by the project will continue to support the Care Coordinators – a permanently funded clinical service – after the project’s conclusion. Transferability : The model tested within the initial cohorts will become standard practice for the Care Coordination Team. Conclusions : Children with even the most complex of conditions can have elements of their care delivered safely in the community provided there is open communication and support available to everyone in the care team, including the family. Lessons learned : A QI framework allows the project to start small and continue to refine as it scales, and the incremental change does not feel threatening to the participants.

IntroductionA high-quality health system should deliver care that is free from harm. Few large-scale studies of adverse events have been undertaken in children's healthcare internationally, and none in Australia. The...

IntroductionAustralian and international clinical practice guidelines are available for common paediatric conditions. Yet there is evidence that there are substantial variations between the guidelines, recommendations (appropriate care) and the care...

Recent rapid advances in genomics are revolutionising patient diagnosis and management of genetic conditions. However, this has led to many challenges in service provision, education and upskilling requirements for non-genetics health-care professionals and remuneration for genomic testing. In Australia, Medicare funding with a Paediatric genomic testing item for patients with intellectual disability or syndromic features has attempted to address this latter issue. The Sydney Children's Hospitals Network - Westmead (SCHN-W) Clinical Genetics Department established Paediatric and Neurology genomic multidisciplinary team (MDT) meetings to address the Medicare-specified requirement for discussion with clinical genetics, and increasing genomic testing advice requests. This SCHN-W genomic MDT was evaluated with two implementation science frameworks - the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) and GMIR - Genomic Medicine Integrative Research frameworks. Data from June 2020 to July 2022 were synthesised and evaluated, as well as process mapping of the MDT service. A total of 205 patients were discussed in 34 MDT meetings, facilitating 148 genomic tests, of which 73 were Medicare eligible. This was equivalent to 26% of SCHN-W genetics outpatient activity, and 13% of all Medicare-funded paediatric genomic testing in NSW. 39% of patients received a genetic diagnosis. The genomic MDT facilitated increased genomic testing at a tertiary paediatric centre and is an effective model for mainstreaming and facilitating precision medicine. However, significant implementation issues were identified including cost and sustainability, as well as the high level of resourcing that will be required to scale up this approach to other areas of medicine.

IntroductionThis article presents an overview of a prospective randomised controlled non-inferiority study designed to evaluate the safety and effectiveness of non-operative management (NOM) with operative management in children with acute...

To describe 30-day outcomes after intrathecal baclofen (ITB) pump placement in children and identify risk factors for readmission, reoperation, and perioperative complication using the National Surgical Quality Improvement Program-Pediatric (NSQIP-P) database. Patients aged 0 to 18years who underwent ITB pump placement (2012-2014) comprised the study cohort defined in the database. Multivariate regression analysis was performed using preoperative and perioperative data from the American College of Surgeons' NSQIP-P database. Outcomes of interest within 30 days of surgery were (1) unplanned reoperation; (2) unplanned readmission; and (3) composite postoperative event, including complication, reoperation, and/or readmission. We identified 423 surgeries; 246 (58.2%) patients were male, 177 (41.8%) patients were female. Median age was 12years and 11months. Median operative time was 70minutes (interquartile range 56-97min). Mean length of stay was 3.8days. The patient population had a high number of medical comorbidities. The overall readmission rate was 7.3%; mean postoperative admission date was 14.1days after surgery. Of readmitted patients, 64.5% underwent reoperation. The most common indication for reoperation was surgical site infection. Female sex was associated with decreased risk of readmission (odds ratio [OR] 0.25, 95% confidence interval [CI] 0.09-0.65; p=0.01); American Society of Anesthesiologists Classification of greater than or equal to 3 was associated with decreased risk of unplanned return to surgery (OR 0.26, 95% CI 0.11-0.66; p=0.04); length of stay greater than or equal to 3days at index surgery was associated with increased risk of composite 30-day perioperative event (OR 2.33, 95% CI 1.29-4.20; p=0.01). Our data provide national perspectives on 30-day perioperative outcomes for ITB pump placement in children. Results illustrate NSQIP-P database collection methodology and highlight opportunities for quality improvement in clinical practice. Seven percent of patients who underwent intrathecal baclofen pump placementrequired readmission within 30days. The most common indication for reoperation was surgical site infection.