The Clinical Paediatrics group’s research seeks to further the diagnosis, investigation and treatment of children with common childhood illnesses who present to hospital. These illnesses include asthma, eczema, cellulitis, gastroenteritis, bronchiolitis, constipation, infant feeding problems, pneumonia, urinary tract infection, pyelonephritis, lymphadenitis, meningitis, febrile illnesses and sepsis. The team aims to improve the understanding of these diseases and how to manage them, to appreciate how the hospital environment impacts on the patients and families and to ensure practice is evidence-based and bench-marked. The group therefore has a strong health services research focus. The team’s strength lies in its wide range of research interests and the capacity to engage and collaborate with a large number of clinicians on campus to translate findings into practice, for the benefit of patients.
The group includes members of the Departments of General Medicine, Dermatology and Ambulatory Services. In addition to clinical research, these departments have a health services research focus. General Medicine has the largest number of Advanced Trainees rotating through any department. A focus of researchers is supervision and mentoring of trainees through their Royal Australasian College of Physicians (RACP) projects. The group also aims to provide research governance and support to clinicians with ideas for smaller projects to ensure high-quality research and outcomes that are translatable.
CHOICE study (Cellulitis: Home Or Inpatient in Children from Emergency)
A study investigating whether children with skin infection needing intravenous antibiotics can be safely and effectively treated at home, rather than in hospital. This is a collaboration between Hospital-in-the-Home (HITH), the Emergency Department and General Medicine. The plan will be to use this model as a platform for more studies in children with other diagnoses.
The use of telemedicine for Hospital-in-the-Home
Telemedicine is potentially a useful adjunct to the care of children at home. We have several related projects underway assessing the usefulness and acceptability of telemedicine for patients on HITH:
- A pilot study of acute medical review by mobile telemedicine for patients on HITH
- A pilot study of physiotherapy via telemedicine as an adjunct to care in cystic fibrosis
- Sleep studies via telemedicine, in collaboration with the Respiratory Department
Health services delivery research to improve the use and quality of Hospital-in-the-Home
The Royal Children’s Hospital (RCH) has the largest paediatric HITH program (Wallaby Ward) in Australia, but there is surprisingly little published about the use and quality of the service delivered by paediatric HITH. The group has several related projects underway to address this:
- The Wallaby Initiative Point Prevalence Survey (WIPPS): an audit of inpatients on a daily basis over several weeks to determine missed opportunities for referral to HITH and the reasons why.
- Factors that influence the use of Hospital-in-the-Home for specific patient groups: in children with specific diagnoses, the aim is to determine which children are referred to HITH and which are not, and to identify factors that promote or restrict referral. The first two diagnoses chosen for investigation are meningitis and pyelonephritis.
- Increasing the use of HITH for children referred directly from the Emergency Department: previously patients attending the ED were not referred to HITH and this was identified as a gap. A quality improvement initiative has been implemented to facilitate referrals directly from ED, with patient and staff satisfaction surveyed, and clinical outcomes of patients assessed.
Children’s HIV Exposure Study (CHIVES)
An assessment of a multidisciplinary inter-hospital maternal and child HIV care model. This health services delivery project aims to assess the follow up these children as outpatients and compare it against our own and others’ standard of practice.
Antibiotic use in children in tertiary hospitals
Increasing resistance to antibiotics is a global and pressing concern. The lack of a standardised way to measure antibiotic prescribing in children means there is a paucity of data about antibiotic use. There is also scant information about antimicrobial stewardship (AMS) resources and activities to manage antibiotic use. The group has several projects underway.
- A multicentre antibiotic point prevalence survey: a single day assessment of all antimicrobials prescribed to all patients in tertiary children’s hospitals across Australia.
- A multicentre survey of AMS resources and activities: a survey of every children’s hospital and adult hospitals with the largest number of children representing every state and territory in Australia and New Zealand.
- Outpatient parenteral antimicrobial therapy (OPAT) study: RCH has the largest OPAT program in Australia, and it differs from overseas programs in several ways. This project aims to assess our use and appropriateness of OPAT.
- Antibiotic prescribing in haematological malignancies – opinions and practice: This project aims to determine whether current prescribing habits reflect the opinions of those caring for patients with the condition, febrile neutropenia, or fever in cancer patients.
Management of infants and children with bronchiolitis using high flow nasal cannula oxygen
This study follows a pilot project on the feasibility of using high flow nasal prong oxygen for infants and children with bronchiolitis. This study will determine the clinical outcomes of patients admitted to the RCH with bronchiolitis and treated with HF O2 over two winters. The results will help refine this treatment to achieve the best outcomes for patients.
Adequacy of blood culture sampling in a tertiary children’s hospital
The aim of this study is to measure the volume of blood submitted for culture in routine clinical practice. The results will determine the proportion of blood cultures submitted with an adequate volume. The effect of an educational intervention aimed at creating awareness around adequate blood culture volumes by age will be determined.
Management and outcome of infants less than three months of age that present with fever in routine clinical practice at a tertiary children’s hospital
Infants under the age of three months are particularly susceptible to bacterial infection, and frequently this presents with isolated fever. RCH has evidence-based guidelines for the management of children under three months who present with fever. This audit aims to assess whether these guidelines are being followed and if not, where are the gaps?
Is my child 'good to go' home now: parental expectations of and barriers to timely admission and discharge from hospital
Demand for hospital services is increasing faster than supply. Large health care organisations will have to be innovative in the way they manage demand and find solutions within existing resources to address this issue. This will rely on hospitals operating more efficiently and optimising processes that are within their control. This study will determine barriers to access and timely discharge by following patients and their families through their hospital journey. Findings will help inform quality improvement initiatives.
- A Comparison of Hospital Versus Outpatient Parenteral Antibiotic Therapy at Home for Pyelonephritis and Meningitis. 2017
- Does a brief, behavioural intervention, delivered by paediatricians or psychologists improve sleep problems for children with ADHD? Protocol for a cluster-randomised, translational trial. 2017
- Medication communication between nurses and doctors for paediatric acute care: An ethnographic study. 2017
- QUESTION 1: What is the risk of a repeat reaction to amoxicillin or a cephalosporin in children with a history of a non-immediate reaction to amoxicillin? 2017
- Quick-Wee: a novel non-invasive urine collection method. 2017
- Alternatives to ward admission from the emergency department. 2016
- Antibiotic duration and timing of the switch from intravenous to oral route for bacterial infections in children: systematic review and guidelines. 2016
- Blood Cultures in Cellulitis are not Cost Effective and Should Prompt Investigation for an Alternative Focus. 2016
- Cellulitis: Home Or Inpatient in Children from the Emergency Department (CHOICE): protocol for a randomised controlled trial. 2016
- Congenital Tuberculosis Complicated by Hemophagocytic Lymphohistiocytosis. 2016
- The QuickWee trial: protocol for a randomised controlled trial of gentle suprapubic cutaneous stimulation to hasten non-invasive urine collection from infants. 2016
- The use, appropriateness and outcomes of outpatient parenteral antimicrobial therapy. 2016
- Voriconazole dosing and therapeutic drug monitoring in children: experience from a paediatric tertiary care centre. 2016
- Who Can Have Parenteral Antibiotics at Home?: A Prospective Observational Study in Children with Moderate/Severe Cellulitis. 2016
- Anti-infective use in children and pregnancy: current deficiencies and future challenges. 2015
- Antimicrobial stewardship resources and activities for children in tertiary hospitals in Australasia: a comprehensive survey. 2015
- Australia-wide point prevalence survey of antimicrobial prescribing in neonatal units: how much and how good? 2015
- Chinese herbal medicine granules (PTQX) for children with moderate to severe atopic eczema: study protocol for a randomised controlled trial. 2015
- Posaconazole: promising but problematic in practice in pediatric patients. 2015
- Where should we measure waist circumference in clinically overweight and obese youth? 2014
- A digital picture is worth a thousand words in a different dialect: improving adherence to antiretroviral medication. 2013
- Antibiotic-resistant Gram-negative bacteremia in pediatric oncology patients--risk factors and outcomes. 2013
- Fifteen-minute consultation: the infant with frequent infections. 2013
- Formal Infectious Diseases Consultations at a Tertiary Pediatric Hospital: A 14 Year Review 2013
- Neonatal Vancomycin Continuous Infusions: Still a Confusion? 2013
- Sleep and infection: no snooze, you lose? 2013
- Susceptibility to acute rheumatic fever: differential expression of genes involved in cytotoxicity, chemotaxis and apoptosis 2013
- Victorian Department of Health
- RCH Telehealth fund
- RCH Emergency Department
- RCH@Home Department and Hospital-in-the-Home program