Outpatient pediatric care closer to home


When two-year-old Shelby Robertson had a liver transplant in Toronto in 2007, her family faced the prospect of relocating temporarily from Kingston to Toronto for months of continuous medical follow-up. It meant loads of commuting for her parents, plus a long separation from her six-year-old twin sisters and all the comforts of home—just when she needed them most.

Instead, Shelby received that vital medical supervision close to home through the Children’s Outpatient Centre (COPC) at Hotel Dieu Hospital in Kingston, where highly skilled pediatric specialists took on the day-to-day management of her follow-up care.

In the past, the Robertsons wouldn’t have had much choice about the setting for post-transplant medical care, Shelby would have been discharged to the immediate community only and certainly not as far away as her home in Kingston.

“In this region, we can now transition those patients home sooner because we have the medical expertise to complete the day-to-day management of their care. We do that in close collaboration with hospitals such as The Hospital for Sick Children (SickKids) and the Children’s Hospital of Eastern Ontario (CHEO)—the places doing very sub-specialized medicine such as transplants or cardiac surgeries,” says Dr. Richard van Wylick, COPC Medical Director. “Essentially, they have their job to do and we have ours. Because that dynamic works so well, pediatric patients and their families can be spared the stress of being away from home at a critical time.”

Every month, COPC pediatric cardiologist Dr. John Smythe sends two or three young patients diagnosed in Kingston with heart disease to CHEO or SickKids for their catheter or surgical interventions. Teleconferencing allows detailed communication with the cardio-surgical teams prior to procedures. The outpatient pre and post-operative care, which generally includes blood work, ECGs, x-rays, echocardiograms and MRIs, is provided in Kingston.

“It’s a continuum of medical care that works extremely well,” Dr. van Wylick says. “Patients and families accept that they have to go elsewhere for the actual procedure, but they much prefer coming to Kingston for the rest of their care. It’s closer to home and we have the pediatric specialists they need. And the pace is more manageable here. That can help to make the medical experience much easier for the family.”

Pediatric expertise in the COPC spans a spectrum of ambulatory specialty clinics including cystic fibrosis, orthopedics, cardiology, diabetes, ophthalmology, food allergies and endocrinology. All share a strong multi-disciplinary approach to health care. Each year, these clinics book 13,000 to 14,000 pediatric outpatient visits.

In addition, the hospital’s Pediatric Urgent Care Clinic stands out as rapid-access pediatric service in a hospital not dedicated exclusively to children’s health care. “The clinic excels as a same or next-day consultation service for young patients, including those discharged from hospital or an emergency room,” says van Wylick.

“Having access to rapid re-assessment through the clinic means more timely discharge and easier follow-up care,” he explains. “Many kids who traditionally would have been hospitalized are receiving highly specialized care here. That means they can recover at home, which eases the stress on them and their parents.”

For community physicians, having access to same-day consultation with a pediatrician is a godsend. Ditto for a parent whose child suddenly spikes a high fever or takes a bad tumble. As a walk-in service, the clinic handles everything from earaches to anaphylactic reactions to severe dehydration. Every year it averages 9,000 to 10,000 walk-in visits, a number that keeps climbing as people continue to have difficulty finding a family doctor. Recently, the clinic boosted its capacity to care for the sickest children when it gained new isolation space with a special air exhaust system to reduce the possibility of bed-to-bed contamination.

For the Robertsons, the COPC came to seem like a second home as Shelby underwent lengthy intravenous treatments and careful monitoring for complications in the months following her transplant. “We developed an amazing relationship with the COPC team. They did whatever they could to support us during those months after the surgery,” says Ken Robertson. “Having those pediatric experts and outpatient clinics so close at hand did us all a world of good.”