Outcomes of triaging and redirecting children referred to a public tertiary paediatric service with developmental–behavioural concerns

Abstract

Every year, approximately 2500 children are referred for developmental or behavioural concerns to outpatient clinics at the Centre for Community Child Health (CCCH), Royal Children's Hospital (RCH), Melbourne. Not all of these children can be seen in a timely manner. Therefore, in 2016, CCCH implemented a triage and redirection plan, similar to other paediatric services, (1) and in line with the Access Policy for Specialist Clinics in Victoria. (2) CCCH now accepts referrals in two situations: RCH is the closest public paediatric service, or; the referral is from a specialist, requesting tertiary review. All other referrals are "redirected"-that is, the referral is rejected and an explanation is sent to the referrer and family, suggesting an alternative public service.We studied the experiences of families who are redirected by CCCH, to ascertain whether their children subsequently received paediatric care.We held phone interviews with caregivers of children referred between October 2016 and February 2018. We collected data including demographics, and families' experiences of redirection and subsequently the health care system (see Appendix 1, online edition only).Of 2718 referrerals received, 405 were rejected. 134 were excluded, because the child was rereferred and seen at RCH, the referral was for Sleep Clinic (as its intake criteria differ to other CCCH clinics), or contact details were incorrect. 271 families were approached; 68 completed surveys. Families were contacted approximately 7 months after referral to RCH (mean 7m21d, SD 1m25d).

Letter to the editor

“…Some patients rejected by public service may need to access an alternate service, usually at significant cost, placing financial strain on disadvantaged families. 2 In July 2017, a public hospital in New South Wales implemented a systematic approach to triaging referrals to the paediatric outpatient clinic using strict new triage criteria. 1 Rejected referrals were often given written feedback (e.g.…”

“…Dr Habib Bhurawala, Head of Paediatrics Conjoint Lecturer 1,2 Dr Tasnoova Ali, Junior Medical Officer 1 Dr Sowmya Gandham, Paediatric Staff Specialist Conjoint Lecturer 1,2…”