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BackgroundChildren with medical complexity (CMC) have high care needs, often unmet by traditional healthcare models. In response to this need, the Complex Care Service (CCS) at The Royal Children's Hospital (RCH), Melbourne was created. While preliminary parent satisfaction data were available, we lacked knowledge of how the various components of the expanded service were valued and contributed to overall caregiver satisfaction. AimThe aims of this study were to 1) determine what caregivers value most about the CCS and 2) explore caregiver perceptions of care. MethodsAll caregivers of children enrolled in the RCH CCS in April 2017 were invited to participate. A purposefully designed survey explored caregiver perceptions of care, including: patient quality of care; the extent to which the CCS components added value and satisfaction; and frequency of contact. Participants were also invited to answer open-ended questions and provide general comments. ResultsResponses were received from 53 families (51%). We found that 24-hour phone advice; coordination of appointments; a key contact; and access to timely information, were the most important components of the service. More than 90% of caregivers indicated that they were satisfied with care and that the CCS improved their child's quality of care. Coordination, communication, family centred care, quality care and access were emergent themes within comments.

Aim To quantify (i) indicated versus non‐indicated prescribing of acid‐suppression therapies (AST) in a tertiary paediatric hospital; (ii) patient, provider and hospital factors associated with non‐indicated prescribing; and (iii) medication costs. Methods This was a prospective, electronic medical audit conducted at The Royal Children's Hospital (RCH) Melbourne in August–September 2016. Proton pump inhibitor (PPI) and histamine‐2 receptor antagonist (H2RA) prescriptions were extracted, with relevant patient, provider and hospital data. Logistic regression analysis of variables associated with indicated and non‐indicated prescribing was undertaken. Costs of indicated and non‐indicated prescriptions were estimated, with annual costs projected. Results There was more non‐indicated than indicated prescribing across inpatient, outpatient and emergency department settings. Of the total 303 prescriptions analysed, 238 (78.5%) were non‐indicated. Gastrostomy presence (odds ratio (OR) 5.51 (1.96–15.46), P = 0.001), consultant providers (OR 2.69 (1.23–5.87), P = 0.01) and inpatient setting (OR 2.35 (1.16–4.77), P = 0.02) were all associated with a higher likelihood of non‐indicated prescribing. The child having a predisposing diagnosis was significantly associated with indicated prescribing (OR 0.41 (0.21–0.80), P = 0.009). A total of 75% of hospital and patient spending was for non‐indicated prescriptions. Annual costs of non‐indicated AST for Melbourne's RCH were projected to be $15 493. Conclusions Non‐indicated acid‐suppression prescribing is common in a tertiary paediatric hospital and associated with gastrostomy presence, consultant providers and inpatient status. Future research should use qualitative methods to understand clinician and patient drivers of prescribing and use this information to develop and test targeted solutions to reduce non‐indicated AST prescribing.

Background The importance of effective and well managed transition care has been increasingly recognised along with the reality that for many it is poorly experienced. National and International policies have emphasized the importance of addressing these shortcomings. Individuals with the rare genetic disorder, 22q11.2 deletion syndrome (22Q11DS) face particular challenges with transition. By virtue of their genetic condition, they are at a highly increased risk of psychiatric disorders along with a variety of medical and educational problems, with the majority experiencing mild intellectual disability, all contributing to unique challenges of transition into adulthood. To date, the experience of these young people navigating this journey has not been well researched. Aim This current project seeks to understand the experiences of a group of young people (Young Experts by Experience Panel, YEEP) as they journey from adolescences to adulthood, interfacing with many different healthcare providers. It seeks the views of YEEP as to methods to optimise this experience, and presents a practical transitional toolkit, designed by the YEEP. Method Young people were recruited via the national support organisation following ethical approval. A semi-structured interview schedule was devised and guided participatory action research regarding transition experience and suggestions for future improvements. Results The overwhelming experience by YEEP members was of a difficult and stressful transition, with poor transfer of information between services and an overall lack of knowledge by the new service providers of their unique needs and disorder (22Q11DS), requiring multiple retelling of their story.Their key recommendations was to develop a 'Transition Toolkit' to assist in the process, acting as a conduit of information from one professional to another, an aide memoire for themselves documenting key appointment dates and treatments and to which they could add useful information and resources. Details of the content/format of this will be presented. Conclusion Optimum transition experience is critical to engagement with the new services, management of the medical condition and overall quality of life. Such care should be planned and co-ordinated, with the young person central to the process, and assisted by the family and clinical teams. Transition training for professionals coupled with the transition Toolkit, should assist in this endeavour. Acknowledgements Support given by Ms Anne Lawlor, Chairperson of 22Q Ireland, and the members of the YEEP group which made the SSRA experience so enriching. This work was carried out as part of medical student elective.