Extremely long Australian paediatric outpatient waiting lists have resulted in large numbers of children waiting to see a paediatrician. Analyses of the patient referrals suggest that a large proportion of children may benefit from allied health input, in addition to being seen by the paediatrician. This paper provides an organisational strategy that involves streamlining Allied Health clinical services in an effort to assist with bringing down a Paediatric Out-patient waitlist. The paper describes principles to guide the formation of a Paediatric Allied Health Multi-Disciplinary team that proposes assessment and brief interventions. The service would focus on supporting the paediatricians through the use of structured procedures, telephone intakes, multidisciplinary triage, shared and standardised assessments, collaborative formulations and reports, brief interventions, clinical-community linkages, and allied health student support. A variety of additional important organisational principles are proposed to facilitate patient flow from the perspective of streamlining administrative processes, having adequate administrative support, shared responsibilities, teamwork, flexibility, carrying out intake assessments, determining which referrals were appropriate for allied health, and working closely with medical staff.
Growing demand for paediatric services has witnessed growing hospital out-patient waiting lists becoming a common occurrence across some Australian hospitals, where some children have to wait for a diagnosis for up to 23 months [
Studies on the types of patients attending paediatric out-patient clinics suggest that many patients may have benefitted from allied health input prior to, or whilst, seeing the paediatricians [
In addition to understanding the paediatric patient cohort, anecdotal assumptions and research on general factors that lead to out-patient waiting lists that have spiralled out of control suggest concerns in the areas of team system, communication, framework and efficiency, misalignment of clinical resources, unclear staff roles, multi-professional autonomy and increasing number of patients referred into the public health system [
Based in understanding the type of cases that often appear in paediatric clinics, and some of the general factors that may contribute to increasing out-patient waitlists, this paper proposes a series of principles to guide a Paediatric Allied Health Model-of-Care that may be used to support the paediatrician’s efforts by streamlining efforts to reduce hospital wait lists. The paper’s focus is on explaining in some detail what each principle strategy is, as identified in the research literature. Through this focus, the reader may obtain some guidance with regards to shaping an existing service.
A review of the literature suggested the following operational principles:
· Principle 1: Structured intake assessments
· Principle 2: Multidisciplinary triage and assessments
· Principle 3: Single shared multidisciplinary reports
· Principle 4: Brief interventions and referrals to community facilities
· Principle 5: Student interns facilitated clinics
The proposed Paediatric Allied Health Model-of-Care embodies work practices which would help to reinforce managerial and reporting structures, encourage collaboration and cohesion, enhance communication, and facilitate the flow of patient care. The team would consist of psychologists, speech pathologists, occupational therapists and social workers, all of whom would be involved in intake assessments and contribute towards multi-disciplinary assessments and brief interventions. The following are descriptions of the operational principles by which they would operate.
Principle 1: Structured Intake Assessments
Referrals received by paediatricians from local General Practitioners may vary in terms of the quality of information provided. Thus, it is necessary to clarify with the parents about their child’s underlying issues and history of the presenting problems via a semi-structured interview. Semi-structured questionnaires have been recognised as an integral mechanism for the execution of collaborative work [
Principle 2: Multidisciplinary Triage and Assessments
The interview information would be reported back to a team, which provides team clinicians with a chance to review cases and reach a consensus on the type of allied health input required [
Principle 3: Single Shared Multidisciplinary Reports
Upon conclusion of the assessments, a shared multidisciplinary report would be compiled for each patient using standardised formats and language which enables various care approaches to be communicated in a unified manner [
Principle 4: Brief Interventionsand Referrals to Community Services
Given that the Paediatric Allied Health Multi-Disciplinary team would be located within a general hospital setting, long term ongoing care or therapy may not always be available. Thus, one of the primary aims of the team would require familiarity with local community services, seek out, and facilitate referrals of patients to appropriate longer-term supports within the community. Where a brief intervention might be of benefit to the patient, the team may offer brief interventions. This decision would be contingent upon the urgency of the patient’s needs and the availability of other potentially more appropriate services. Examples of common brief interventions that may be utilised include components of parenting programs, child behaviour management, anger management, social skills training, attention focusing strategies, handwriting skills, visual perceptual tasks, sensory integration, speech, language and literacy therapies, and cognitive behavioural interventions to reduce anxiety.
Principle 5: Student Intern Facilitated Clinics
Utilisation of student interns within a Paediatric Allied Health Multi-Disciplinary service would help to facilitate a larger number of patients being seen through the service. Student-supported clinics have become increasingly popular in recent years due to the growing need within Australia to increase patient capacity and expand student placement opportunities [
In setting up a Paediatric Allied Health Multi-Disciplinary service, dealing with complex, multi-layered patient care requirements would be a constant challenge and thus a collaborative and well-coordinated approach would be required.
There would be both strengths and limitations with regards to this Paediatric Allied Health Multi-Disciplinary Model of Care. The strengths included saving the paediatricians time where requiring more detailed assessment results to make informed diagnostic decisions are concerned. As a result, the recommendations for therapy made by both allied health professionals and the paediatricians would be comprehensive. Given that structured intakes, standardised assessments, and subsequently standardised multidisciplinary report templates are used, the capacity for attending to larger numbers of patients attended to in a streamlined manner would be possible. No model of care is without its limitations, and as a multidisciplinary approach may result in over-diagnosis, the Paediatric Allied Health Multi-Disciplinary team would have to limit assessments to those which address the main Paediatrician or General Practitioner referral question or request. As the specialised nature of the work involves complex multidisciplinary assessments, the manner of communicating findings to the stakeholders involves a large amount of report writing, which may place a heavy burden on clinician time. Thus, there was a constant need to source less time consuming ways of scoring assessments and write reports.
In addition to the operational principles provided, several other logistical considerations may enable more efficient functioning of the paediatric allied health team. These are detailed in the following sections.
Teamwork, open communication and a shared set of values would facilitate the manner in which the team carries out its daily activities. The challenge would involve moulding experienced clinicians into a collaborative working unit that would work efficiently to ensure a large number of patients continue to be attended to. The multidisciplinary team would be led by a team leader whose role provides effective management which is an integral part of collaborative work. Ovretveit [
Without a well-coordinated and collaborative approach, patient care may become fragmented, healthcare may be under or over-utilised, and patients may become “lost” in the system [
When catering to the needs of students within the team, there are several recommendations. Firstly, students need to have clinical supervisors who are trained and have the appropriate clinical and supervisory qualifications. The manner in which interns are integrated into the team would need to be facilitated via pre-internship briefings and active participation in meetings, both of which facilitate team communication, a sense of belonging and an attitude of respect. Simply participating as a member of the team and being supervised would not be enough to facilitate student learning of practical skills, and there needs to be a set of resources available that addresses assessments, diagnostic and treatment issues. Supervision also needs to be carried out in a mixture of individual and group modes to ensure that student’s individual training needs are considered and that an opportunity exists for broader learning through the shared discussion of cases.
Principles guiding the formation of a Paediatric Allied Health Multi-Disciplinary model-of-care are proposed to help reduce the paediatric outpatient waiting list. Gradual reduction of the waitlist could begin with an audit of the types of patients presenting to the clinics and considering the types of clinicians best suited to attend to these needs. Following this, the operational processes that contribute to the workability of this model would include structured phone intakes, multidisciplinary triage, assessments, formulations and reports, structured procedures for reports, and intern supported clinics. Setting up teams across health care services would need to be mindful of the current type of case load and also local administrative requirements in order to decide on the type and proportion of allied health disciplines required.
Some aspects of the literature review for this paper have been funded by a grant from the Allied Health Professions Office, Queensland Health, Australia (Grant Ref: AH001082).
The authors declare no conflicts of interest regarding the publication of this paper.
Teoh, H.-J. and Darvell, M. (2021) Reducing Paediatric Outpatient Waitlists—A Proposed Allied Health Multidisciplinary Approach. Open Journal of Preventive Medicine, 11, 63-70. https://doi.org/10.4236/ojpm.2021.112006