The RCH Complex Care Service is a new model of care, created, piloted and evaluated in 2014-15, to unite a whole of hospital approach to better support complex patients and their families.

It is an international and growing phenomenon that a small proportion of patients with complex needs use a disproportionately large amount of healthcare services. These children have complex medical healthcare needs, requiring multiple stays in hospital and frequently visit the RCH Emergency Department. These patients represent approximately three per cent of all patients, but account for fifteen per cent of entire hospital bed days.

In response to this problem the RCH convened a steering committee and a project team to review the legitimacy of a new and innovative model of care, the complex care service. From the outset, the RCH defined complex children as having multiple admissions in the past 12 months, multiple diagnoses with three or more medical teams involved in care, frequent presentations to Emergency and Specialist Clinics and having community service providers involved in their care.

The project team developed the foundations for the service with consultation and direction from families, patients, staff and community service providers. Baseline data was collected on their bed days, ED presentations, inpatient admissions and Specialist Clinic appointments. Families also completed a survey to understand their satisfaction with existing service provision.

A Clinical Nurse Consultant was allocated as the Complex Care Coordinator for these families. The key services offered to patients and families were care coordination, timely access to advice and support and family partnership.

“The positive results delivered by the Complex Care service are twofold: improved patient and family experience, leading to better quality of life and wellbeing and more efficient use of RCH resources to the benefit of other patients and the broader community,” Complex Care Clinical Nurse Consultant Nicki Mountford said.

In the first twelve months, the Complex Care service delivered a 50 per cent reduction in bed days and Emergency Department presentations for children in the service as well as a 77 per cent positive response in the patient and family satisfaction survey (30 per cent improvement).

The RCH Complex Care service will now scale up in a measured and staged approach over the next two years to accept up to 200 patients and their families. The connections and collaboration between departments and services, both within RCH and the community, which is necessary to support this complex care model requires a change in work practices and behaviours.

A core component of innovation is an acute customer focus and this new model of care is moving from a service driven model to a consumer driven model of healthcare.

The RCH Complex Care service is unique in that it is a multidisciplinary service that is integrated across all domains of care – inpatient, outpatient and community. By having a clear clinical lead to integrate and connect services the hospital is moving from a crisis driven model to a proactive model of care and empowering families to manage their child’s healthcare.

The RCH Complex Care service is unique to paediatric care in Victoria. The organisations long-term commitment to improving the care and experiences of complex children, is driving this innovation and ensuring great, patient and family centred care.

If you have any questions about the Complex Care Service please speak to your doctor at the RCH.

Read more about the RCH in the 2014/15 Quality of Care Report.