Reducing time between referral and diagnosis in paediatric outpatient neurodevelopmental and behavioural clinics

Abstract

Aim This study investigated the impact of a transdisciplinary advanced allied health practitioner (AAHP) in a public hospital general paediatric outpatient department for children referred for concerns with neurodevelopment, learning and/or behaviour. It was hypothesised that time from referral to initial consultation and diagnosis was reduced for children initially assessed by AAHP. It was also hypothesised that children seen by AAHP were less likely to require a medical specialist appointment. Methods De‐identifiable data were gathered from hospital records both retrospectively and prospectively for each group. Data were collected from: 75 children who attended a medical consultation only clinic in 2014; 75 children who attended an AAHP clinic and a medical officer in 2014 and 75 children who attended an AAHP clinic and a medical officer 2 years after establishment in 2016/2017. Results On average, 52% children were managed independently by the AAHP. Wait time from referral to consultation significantly decreased from 169 days to 48 days. Similarly, time from referral to diagnosis significantly reduced by almost a half, from 57.2 to 30.59 weeks. Conclusion This study provides preliminary evidence that utilisation of transdisciplinary AAHPs in general paediatric outpatient departments may reduce waitlists, reduce amount of medical specialist appointments required and provide earlier diagnosis for children with neurodevelopmental, behavioural and/or learning difficulties.

The Well-being and Support Needs of Australian Caregivers of Neurodiverse Children

“…This includes evidence-based, professional education and training to caregivers, including relating the early signs of their child’s diagnosis (Bent et al, 2020 ). Currently, while awaiting assessment and diagnosis for their neurodivergent child, caregivers are not provided with support or information to assist them (Creen et al, 2021 ). This lack of support was found to negatively impact caregivers’ mental health and well-being, as they experience difficulties knowing how to best support or understand their child’s behaviours.…”

Service redesign interventions to reduce waiting time for paediatric rehabilitation and therapy services: A systematic review of the literature

“…No study randomised participants to intervention and comparison groups and less than half (15 of 33) used any inferential statistics to test the hypothesis that the redesign intervention was associated with a change in waiting time. Only five studies provided any information about the characteristics of the groups being compared and therefore about confounding variables, (Ahlers et al, 2019 ; Camden et al, 2013 ; Creen et al, 2021 ; Hine et al, 2020 ; Horton & Hall, 2008 ) and there was uncertainty about how waiting was defined or measured (i.e. the validity and reliability of outcome measures) in 14 studies (42%).…”

“…the validity and reliability of outcome measures) in 14 studies (42%). A total of 29 studies did not fulfil the criterion of collecting data over the same period of time, as they used historical comparison groups, and of the four studies using concurrent comparison groups,(Clemente et al, 2006 ; Creen et al, 2021 ; Harrison et al, 2017 ; Horton & Hall, 2008 ), two were from a separate service that could not be considered the same population (Clemente et al, 2006 ; Horton & Hall, 2008 ). Further details are presented in Appendix S3 .…”

“…Eleven studies were identified (Table 3 ) that evaluated interventions in which a service usually provided by a specialist was provided by other members of a healthcare team to increase treatment capacity (Ahlers et al, 2019 ; Belthur et al, 2003 ; Choueiri et al, 2021 ; Creen et al, 2021 ; Harrison et al, 2017 ; Hine et al, 2020 ; Hurtubise et al, 2017 ; Mathai, 2007 ; McClure et al, 2010 ; Mir et al, 2016 ; Williams‐Arya et al, 2019 ). This category included five autism services (Ahlers et al, 2019 ; Choueiri et al, 2021 ; Hine et al, 2020 ; McClure et al, 2010 ; Williams‐Arya et al, 2019 ) and two behavioural assessment clinics (Creen et al, 2021 ; Harrison et al, 2017 ) in which assessment roles were distributed to either trained allied health professionals or a multi‐disciplinary team, reducing dependence on specialist roles such as a psychologist or paediatrician. Three studies (two general orthopaedic services and one cerebral palsy clinic) involved physiotherapists doing work previously done by medical specialists (Belthur et al, 2003 ; Hurtubise et al, 2017 ; Mir et al, 2016 ).…”

“…Qualitative data regarding staff satisfaction were reported in two studies in the rapid response category; both reported the changes to have had benefits in relation to collaboration, but noted concerns about increased time pressures from some participants (Clemente et al, 2006 ; Fuggle et al, 2016 ). Six studies considered services offered following an initial appointment; two studies measured the proportion of children needing further evaluation after initial assessment using a rapid response model (Hayes & Caygill, 2004 ; Jones et al, 2018 ) and four studies reported the proportion requiring further assessment by a specialist physician (Creen et al, 2021 ; Hine et al, 2020 ; Mir et al, 2016 ; Rutherford et al, 2018 ) after initially seeing an alternative/substitution professional. All reported that clinically significant numbers of children could be discharged without requiring further care.…”