Outreach Services

A Hospital Without Walls

Ensuring that sick children living in the country are not disadvantaged by distance is a priority with The Children's Hospital at Westmead. It's very much a part of our commitment to improve clinical services to the community and to allow fair access to the best medical care.

One of our methods is through outreach clinics, where we take our doctors to the sick children. In this way, many of the traumas often associated with country children having to come to the city (not the least of which is the disruption to normal family life) are minimised, and sometimes eliminated altogether.

During outreach clinics, specialist doctors travel to regional centres for consultations with local children, who can either be regular recipients of treatment (for example, diabetic children), former patients of the Hospital or newly referred patients.

Outreach clinics are an invaluable process by which the seriousness of a sick child can be ascertained, usually when the local doctor is aware that a case is beyond their diagnostic ability. For example, a child may have a heart murmur which the visiting specialist can assess. Should it not be a source of concern, then there is no need for that child to be taken to the city to hospital. On the other hand, the specialist may recommend that the child does need further tests, and in that case, a trip to the city is well justified.

The frequency and duration of the country clinics varies - depending on demand and local services - and can range from four days a year, to weekly. Currently there are 26 regional centres who host outreach clinics from 18 departments from the Hospital:

• Adolescent Medicine;
• Cardiology;
• Child Protection Unit;
• Clinical Genetics;
• Endocrinology;
• Ear Nose & Throat;
• Gastroenterology;
• Genetic Metabolic Service;
• Neurogenetics;
• Neurology;
• Nephrology;
• Ophthalmology;
• Paediatrics;
• Paediatric Surgery;
• Psychological Medicine;
• Rehabilitation;
• Respiratory Medicine;
• Spina Bifida.

These Departments, through their outreach clinics, have provided excellent service models. Increasingly, the trend is to work with local communities so we can align our services and philosophy of care much closer to their needs. With increased use of technology, a true, co-ordinated "shared care" approach can be established with other health workers in regional centres. This also helps overcome the problem of the professional isolation faced by some health workers.

Recent years have seen a significant expansion of some outreach clinics, for example general medicine, diabetes, ophthalmology, and in clinical departments which treat osteoporosis and genetic conditions. The Department of Oncology is currently exploring the possibility of a "different" type of outreach clinic, where the focus is more on skills-upgrading of the local doctors rather than the treatment of patients.

An ever-growing demand, as well as technological advances in communication, has led to not only the expansion of outreach clinics, but outreach services generally. Falling under the umbrella of Telehealth, Telepsychiatry and Teleradiology now provide services to country areas. Telepsychiatry, which offers skilled psychiatry to where it is most needed, has now been established in collaboration with seven rural Area Health Services. The Department of Teleradiology has successfully completed a teleradiology trial with Dubbo Hospital and negotiations to establish this service to other regional hospitals are continuing. Teleradiology is now also linked to radiologists at home and selective hospitals in the Greater Western Sydney area.