Trauma Surgery

With a responsibility to treat the most severely injured children, it’s essential that The Royal Children’s Hospital remains at the forefront of great trauma care. Dr Warwick Teague is ensuring that happens.

Taking on the role as Director of The Royal Children’s Hospital Trauma Service, Dr Teague leads a team which oversees the hospital’s protocols and procedures for care of severely injured children.

Dr Teague’s passion is to ensure these processes of trauma care are well maintained and, where possible, improved.

A leader in its field, RCH Trauma Services works to constantly improve the patient and family experience through robust and evidence-based systems.

From a shift handover involving every care team responsible for a trauma patient, to a dedicated call centre for trauma teams across The Royal Children’s Hospital and Melbourne to discuss cases, each system presents a unique and comprehensive approach to trauma care.

“One of the reasons I packed up and moved from Adelaide is that there’s something about this hospital and its opportunities. My role is a unique and precedent-setting one for the campus, and I’m thrilled to hold it.”

trauma-surgery — Dr Warwick Teague, Director of The Royal Children’s Hospital Trauma Service

As part of this funded position, Dr Teague continues his work as an academic paediatric surgeon. Focusing on general, neonatal and burns surgery, Dr Teague will also pursue laboratory research into the gastrointestinal disorder, Duodenal Atresia.

Dr Teague has an enthusiasm for understanding how the body develops before birth. By understanding the ways in which the body develops normally, doctors will unlock the reasons why abnormal changes occur.

For Duodenal Atresia, Dr Teague is keen to find out how and why the blockages indicative of the condition are formed in the intestines or duodenum.

“It’s exciting to be part of evolving great care. In my role, I’m finding ways to improve hospital systems and participate in transforming surgery research.”

“Seeing how this work helps patients makes me passionate about what I do. I have never regretted focusing on paediatric surgery and I cannot imagine another field to go into. I’d be lost. I’m life-committed to paediatric surgery and The Royal Children’s Hospital is the best place to be.”

Posted December 2016

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Allied Health and Nursing Education

The vital element of great care is finding and fostering exceptional people. Thanks to a $3.26 million donation through the Good Friday Appeal, RCH staff are advancing their clinical skills through ongoing education and development.

These funds directly benefit Allied Health Professionals (AHPs) and nurses, who make up over half of The Royal Children’s Hospital staff and collectively care for children, adolescents and their families across all areas of the hospital.

This investment in The Royal Children’s Hospital team ensures the hospital attracts and retains the best and brightest minds, and remains a centre of excellence in paediatric healthcare.

“This opportunity for RCH Allied Health and Nursing staff is unique and enables us to support our staff to ensure the best, evidence based care for RCH patients. Through this generous funding, we can support our staff to learn, develop and deliver excellent care.”
– Bernadette O’Connor, Director of Royal Children’s Hospital Allied Health

Advancing Allied Health
Through Good Friday Appeal support, 180 AHPs have pursued professional development through local and national training courses, seminars and conferences. A number of these AHPs have presented papers on great care and innovation in their work on behalf of the hospital.
The learning acquired at these events is also benefitting other staff members. Attendees are sharing their insights through their departmental continuing education programs and staff education committees.

Nurturing nursing education
It’s paramount for nurses to grow their knowledge and skills to improve clinical practice outcomes for RCH children. Thanks to Victorian support for the Good Friday Appeal, 63 nurses have received the funding necessary to complete their post graduate qualification in the past year.
Many of these nurses have gone on to make significant contributions that have advanced the quality and safety of care provided at the hospital. This has occurred through investigating and leading practice change, bringing increased expertise to teams and taking on leadership positions.

Posted December 2016

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Complex Care Service

These children require multiple specialists and services involved in their treatment, which can be extremely challenging for families to coordinate and manage. With the new Royal Children’s Hospital (RCH) Complex Care Service, this is changing.

The RCH Complex Care Service is a new way of working, created, piloted and evaluated in 2014/15, to better support complex patients and their families.

The complex care team believes that the most successful care comes from partnership, which is why there is now a specific team dedicated to working with complex patients and their families.

By offering additional support, the needs of the patient and their family can be better managed and the impact of the child’s illness on the family is lessened.

The dedicated team, consisting of a Clinical Nurse Consultant (CNC), a doctor, an administration assistant and a social worker, work closely with the family to understand their needs and develop care and emergency plans to meet them.

“The CNC, acts as a single point of contact for the family, providing 24/7 access to advice and support liaising with all the child’s health care providers, both inside and outside of the hospital. This not only takes pressure off the family to coordinate the child’s treatment, but results in improved coordination of care as all of the patient’s health professionals are kept informed, enabling a holistic approach to the child’s care,” says Nicki Mountford, RCH Clinical Nurse Consultant.

The team help the family to better navigate the hospital system in any way they can. Whether this is by coordinating their appointments, helping to connect the family with community supports, or by providing advice or answers to any questions they have, The Royal Children’s Hospital Complex Care team is keen to support the family in any way possible.

“This increased level of support and coordination for the families means that they are attending The Royal Children’s Hospital less frequently and spending more time enjoying life outside of the hospital.”
– Nicki Mountford, RCH Clinical Nurse Consultant

Posted December 2016

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Wadja Health Service

The team runs regular clinics with both paediatricians and Aboriginal Case Managers to deliver holistic care that incorporates Aboriginal and Torres Strait Islander patient’s medical, social, cultural and emotional needs.

Wadja Manager Selena White said Wadja Health Clinic has played a significant role in delivering the best health outcomes for children and families at the RCH.

“When Wadja commenced in 2009, our paediatricians saw three patients in its first month of service, and this has now significantly grown to between 28 – 38 patients a month,” Selena said.

“Last year, our Wadja Case Managers supported more than 300 patients and families with attendance, cultural support and safety throughout clinic consultations.

“Wadja was a new model of care for paediatric health, so it’s great we’ve had such positive feedback from families – knowing our Koori community value our service is very rewarding.”

In 2017, the clinic implemented an enhanced model of care for Aboriginal patients who fail to attend outpatient appointments, to identify and address barriers to accessing health services.

“I’m very proud of how the team has worked together to develop our service to improve the overall health of Aboriginal and Torres Strait Islander children,” Selena said.

“Together we have built trusting relationships with families, formed partnerships with Aboriginal Community Controlled Organisations, and collaborated with many other RCH teams – including Social Work – Vulnerable Children, Mental Health and the Education Institute – who are all very much involved in service delivery and care co-ordination of Aboriginal patients’ who attend our clinic.”

During the COVID- 19 response this year, Wadja Health Clinic clinicians have adapted the outpatient service model to Telehealth to ensure Aboriginal patients and families have ongoing access to the service.

“Many of our families have welcomed consultations via the Telehealth platform and we plan to maintain this option where clinically appropriate post COVID-19,” Selena said.

Despite the COVID-19 limitations, the Wadja team has seen an increase in presentations over the past twelve months, providing care to 3,612 Aboriginal and Torres Strait Islander children and their families during the 2019-20 financial year.

Since its establishment, Wadja has significantly enhanced the experience of Aboriginal and Torres Strait Islander patients at the RCH.

“Wadja is a leading model of care for indigenous child health, and what the team has achieved over the past 10 years has been fantastic,” Selena said.

“Of course, this is something we want to keep building on, so we’re looking for opportunities to improve the effectiveness of our service and ensure we have a comprehensive approach to meeting the needs of our patients and families.”

“We’re also looking to enhance our physical environment, to reflect the traditional owners of the land, and we’re working on strengthening relationships between the RCH and the Aboriginal community by increasing engagement with Aboriginal organisations, Aboriginal elders and community members.”

Posted December 2016

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RCH Telehealth

Children living in rural and regional areas often have limited access to specialist healthcare, with fewer paediatricians and subspecialty services available locally.

As the main provider of outreach and subspecialty services in Victoria, The Royal Children’s Hospital is using its leadership position to innovate how we deliver care to rural and regional patients.

RCH Telehealth is the solution. By improving access to important healthcare services in an easy to use and financially sustainable way, patients receive better care, and scheduling pressures for in-hospital appointments are reduced.

RCH Telehealth began in 2011 with a consultation pilot. The results were clear: online video consultations reduced patient travel time, patients’ time away from school, parents’ time away from work, associated costs and disruption to family life.

Today, 60-100 Telehealth appointments are provided each month by more than 100 different clinicians.

One of the most recent departments to implement Telehealth is Occupational Therapy. Assessing a patient’s functional needs after injury or surgery, Occupational Therapists play an important role in ensuring patients can be discharged.

Part of this process requires Occupational Therapists to have a good understanding of the home environment a patient’s returning to. When a patient lives in a rural or regional area, it can be difficult to organise a home visit.

Through a successful pilot project, the Occupational Therapy team found that eighty per cent of parents felt a Telehealth home assessment was helpful in preparing for their child’s discharge.

Also, with seventy per cent of the patients in the pilot living more than 50 kilometres from the hospital, the study found that Telehealth offered them a practical way for the Occupational Therapist to assess their home.

Posted December 2016

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Simulation Centre

By exposing teams to acute, but rare patient events in a safe environment, the program is improving clinical decision making, enhancing communication skills, and furthering great patient and family care in the most critical situations.

With staff from multiple departments working closely to deliver great care, it’s important that everyone is clear on how teams work together to deliver the best patient outcomes. Replicating critical patient care scenarios gives staff the opportunity to gauge how they react in difficult situations and understand the strengths and weaknesses of each team.

“The strength of our Simulation Program is our ability to recreate rare events, to bring them to life and let people fully experience them,” says Associate Professor Meredith Allen, Director of Medical Education. “Staff become immersed in the process, and are able to enhance their skills and reinforce their clinical response.”

To ensure the simulation experience is realistic, the Good Friday Appeal has supported the purchase of high-tech mannequins that imitate human responses.

Able to breathe, cry, talk, seize and bleed, these mannequins also mimic heart and lung sounds. Each mannequin is controlled by a Simulation Technologist, who ensures that they react appropriately to each simulation, reinforcing critical skills and making each simulation as authentic as possible.

“It’s difficult to comprehend just how isolated you might feel in critical situations until you experience them firsthand,” says Jenni Sokol, Clinical Lead for Simulation. “Education helps, by training teams to work together efficiently and mitigating human error.”

RCH Medical staff train on childlike simulators that mimic emergency situations on the wards like a cardiac arrest. Nursing staff Matthew Stockton and Ella Scott ‘resuscitate’ a patient.

The simulation program also offers staff the opportunity to get feedback on their communication skills through the use of highly trained actors. Scenarios challenging our staff to deliver the most difficult news have been created from real events and are offered back as training opportunities. The actors are highly trained to provide feedback that helps participants navigate through some of the most challenging parts of being a health professional.

Though challenging, the realism of simulations is what makes them an effective way to train staff. Participants experience the same emotions and responses they would in a genuine high-pressure situation, and this makes a lasting impression. There is evidence that staff retain more knowledge and behavioural skills through simulation-based education than through book learning and lectures.

“To work together efficiently as teams and deliver the best patient care, we need to break down the silos we’ve traditionally trained in and focus on enhancing our skills collaboratively,” says Jenni. “The aim for the program has always been to turn groups of experts into expert teams and we’re making great progress in achieving that.”

Posted December 2016

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Nuclear Medicine SPECT/CT Machine

This combined machine includes a SPECT gamma camera, integrated with a CT scanner, meaning for the first time at The Royal Children’s Hospital, these two different types of images can be taken together during one visit. It’s already having a big impact, supporting patients from across the hospital.

What is SPECT?

SPECT stands for single photon emission computed tomography. With this type of scan, images are taken once a patient has been administered with a radioactive tracer. This tracer is then detected by a SPECT camera, which rotates around a patient’s body to produce a three dimensional image.

What is CT?

CT or computed tomography scans are obtained when an X-ray machine rotates around a patient to provide a three dimensional image of their anatomy.

Duncan Veysey, Deputy Chief Medical Imaging Technologist and Senior Nuclear Medicine/PET Technologist at The Royal Children’s Hospital explained how the combined SPECT/CT Machine is able to take both of these scans at the same time, improving patient care at the hospital.

“The combined machine enables us to overlay these two types of scans. We can use the image taken from the CT scan to identify exactly where the radioactivity displayed in the SPECT image is in a patient’s anatomy,” said Mr Veysey.

For clinicians, these more detailed images mean they can diagnose conditions and recommend a treatment plan with greater certainty and accuracy. Being able to do this is particularly important for patients with complex medical conditions, who require specialised and ongoing care.

“We are fortunate to have this top of the range, flexible model at The Royal Children’s Hospital, and are very thankful to our community of supporters for funding such a vital piece of equipment.”
– Duncan Veysey, Deputy Chief Medical Imaging Technologist and Senior Nuclear Medicine/PET Technologist

Posted December 2016

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MR PET

The nine tonne, $6 million Magnetic Resonance Positron Emission Tomography machine, or MR PET, was funded by community donations through the Good Friday Appeal.

RCH Neurologist Dr Simon Harvey said the MR PET combined the most effective medical scanning procedures, Medical Resonance Imaging (MRI) and Positron Emission Tomography (PET), into one piece of equipment for the first time.

“For our young patients, some of whom require sedation and even general anaesthetic to undergo these important but intimidating procedures, the MR PET will means fewer scans, and therefore a more positive experience,” Dr Harvey said.

“It also means more accurate diagnoses, because in addition to giving us high quality MRI and PET scans in one session, the MR and PET will be accurately overlaid into one image.

What is a PET scan?

PET is a form of metabolic imaging – an imaging technique that uses radioisotopes and provides critical information about the metabolic state of body tissues. Doctors use PET scans to identify and monitor tumours, areas of inflammation and sites of seizure activity.

What is an MRI scan?

MRI is form of structural imaging – an imaging technique that provides doctors with critical information about the structure and function of body tissues.

“This will show us, very precisely, the location of tumours, malformations and sites of inflammation in the body, many of which might not be visible with the single images.

“The MR PET will be used to assess and diagnose a wide range of patients, but it has particular advantages for children with certain forms of cancer, uncontrolled epilepsy and inflammatory disorders.”
– RCH Neurologist Dr Simon Harvey

The MR PET was transported to The Royal Children’s Hospital on a semi-trailer and manoeuvred into its new, purpose-built, copper-lined lab in the Medical Imaging Department via a 20 tonne forklift and a team of eight people. The copper shielding is to ensure the operation of the MR PET magnet does not affect other areas of the hospital.

Posted December 2016

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Improved imaging services

Located within what was the Front Entry Building of the old hospital, 48 Flemington Road features many medical centres run by hospital clinicians.

It’s a “home away from home” for these clinicians, making them more available to patients and helping to provide them with better care. However, great care includes not only high quality medical consultations, but also accessible medical imaging services.

Thanks to community support through the Good Friday Appeal, 48 Flemington Road will soon feature its own imaging services.

Specifically, your generosity will fund a fixed x-ray machine with its own waiting room, as well as two ultrasound machines within the same facility.

“The new imaging facilities will provide convenient access for patients seeing their doctor at 48 Flemington Road to the latest digital x-ray and ultrasound machines. Integrated with the main RCH imaging archive system, clinicians will have a complete patient imaging record. The new facility will create a flow on effect for patients at The Royal Children’s Hospital, allowing better access to imaging and reduced waiting times.”
– Padma Rao, Director of RCH Medical Imaging

Posted December 2016

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Hydrotherapy Pool

Since its opening in 2013 the pool has become a vital part of Royal Children’s Hospital (RCH) physiotherapy. By helping children achieve what they can’t do on land, the program is a fun and effective way to provide great care to infants, children and adolescents.

The RCH pool is specifically heated to a warmer-than-usual 34 degrees Celsius, which aids recovery through relaxation of muscles, reduction of muscle spasm, increased circulation and pain relief.

It can also facilitate the treatment of children with a limited ability to regulate their own body temperature.

Aquatic Physiotherapy uses the buoyancy of water to assist treatment. Water acts by assisting and resisting movement which helps increase muscle strength and joint movement.

This form of therapy is great for children with everything from sports injuries to chronic conditions like cerebral palsy, as it allows them to complete exercises and participate in activities which they aren’t able to do on land.

When designing a pool for clinical use, the health and safety of patients is of the utmost importance.

“Unlike many adult hydrotherapy pools, our purpose built facility includes shallow water, a ramp and specific equipment to enable training of running, walking or crawling in young children and infants.”
– Emily Ramage, Senior Physiotherapist

Hydrotherapy physiotherapist Daniella Feuerlicht plays with cardiac patient Davina

“Seeing a child’s face light up as they master a new skill or regain the ability to walk, hop or run in the pool is a special moment. But even more rewarding is seeing these therapy gains translate to the child’s everyday abilities at home, in the playground and beyond.”
– Emily Ramage, Senior Physiotherapist

Photo: David Caird, Herald Sun
Posted: December 2016

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