In this section:
Introduction
The department provides a tertiary level consultative and management service for paediatric respiratory patients primarily to the Queensland Health Southern zone but with extension to the whole state of Queensland and northern New South Wales. It is the only Sleep Medicine service for the state of Queensland and for Northern NSW. [population base approx 4.5 million]
In keeping with general trends in health care, the management of respiratory disease in children is continuing to move to an ambulatory outpatient care model; this forms a significant part of the existing service in respiratory and sleep medicine. Clinics are conducted in regional centres to facilitate care for the patient in their own environment.
Clinical areas of service of the department can be divided as follows.
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Paediatric Respiratory
A multidisciplinary team, comprising medical, nursing and allied health, care for patients with congenital pulmonary and airway lesions, complex respiratory infections, asthma, bronchiectasis, and interstitial and restrictive lung disease. The unit offers a consultative service to the hospital [PICU, NICU, general paediatrics, paediatric surgery, ENT, cardiac services, etc] and the regional paediatric services. Other closely affiliated services are radiology and pathology, paediatric surgery and the child youth mental health service.
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Sleep Medicine and NIV service
The unit provides a diagnostic, consultative, teaching and therapy-based service covering disorders in sleep related breathing, behaviour, sleep phase and neurological disorders. A sleep service has been provided for over fifteen years, with referrals from the whole state of Queensland and northern New South Wales.
Sleep investigation services include oximetry and actigraphy services and polysomnography, with a five-bed polysomnography laboratory — which is the only tertiary level paediatric sleep investigation unit for the state of Queensland.
A developmental paediatrician, with a strong interest in sleep related disorders, is associated with the clinic. Management and investigation is in conjunction with ENT, neurology and child psychiatry.
This service instigates and co-ordinates a home ventilatory support service for patients from Queensland and northern New South Wales—currently caring for nearly 100 children requiring home nasal mask ventilatory support (CPAP and bi-level pressure support).
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Cystic fibrosis
There is a multidisciplinary approach, comprising respiratory, general paediatrics, gastroenterology, clinical nurses, physiotherapists, dieticians, occupational therapists, social workers, liaison psychiatry from child and adolescent mental health and a school teacher.
Close association exists with endocrinology, ENT and Queensland genetic services. The clinic is the smaller of the two tertiary paediatric CF services in the state with approximately 100 patients. An adult service for the southern zone of Queensland health exists at Mater Adult Hospital and offers the opportunity for co-ordinated transfer to adult services.
The clinic has established an outpatient physiotherapy service and a home therapy program with both clinical nurses and physiotherapy to minimise hospital inpatient stay for patients.
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Home Supplemental Oxygen Service including CNLD
The service averages 50 active patients on home therapy with the majority being ex-premature infants. Care is shared with general paediatricians, both locally and in the regional centres. Referrals are received from the state and northern NSW with the majority being referred initially from Mater Mothers' Hospital neonatal unit. Mater Mothers' Hospital is one of the largest birth hospitals in Australia with nearly 8,000 births per year. The neonatal unit has 79 ventilator and high dependency beds.
The multidisciplinary team includes respiratory, clinical nurses, physiotherapy, occupational therapy, speech pathology, dietetics and social work. Close liaison exists with neonatology, developmental paediatrics, cardiac services, ENT and paediatric surgery.
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Home Airway Support Service—Tracheostomy and Nasopharyngeal
A multidisciplinary service for infants and children who require airway support with either tracheostomy or nasopharyngeal tubes/stents. This is coordinated with ENT to manage this group of children at home, and combines the sleep medicine investigatory tools with outpatient services.
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Polysomnography laboratory
Five purpose built beds with full digital polygraphic acquisition (up to 32 channels) and synchronised digital video. The facility performs 550+ full polysomnograms per year and MSLT’s on an as need basis. The patients are cared for during the study on a one to one basis by paediatric RN's who are skilled in real time scoring of the acquired data. 5 of the RN/techs and the 2 scientists have achieved registration from the BRPT USA. Two full-time sleep scientists are part of the laboratory.
The unit has been accredited for training of paediatric sleep medicine under the guidelines of the Thoracic and Sleep Medicine SAC for the RACP.
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Lung function laboratory
This is a joint service with adult and paediatrics (70% of tests preformed are paediatric). The laboratory is able to perform static volumes, real time flow loops, closing volume and diffusion measurements, maximum inspiratory and expiratory pressures, bronchial provocation and skin allergy testing and full cardiopulmonary exercise testing with treadmill or bike. A full-time senior scientist manages the laboratory.
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Flexible bronchoscopy
The unit provides this service to the hospital and region. The hospital facilitates this with a dedicated operating time and 5 flexible bronchoscopes with video imaging ranging in size from 2.7 mm to 4.9 mm. The full-time paediatric anaesthetics have extensive skills in the management of the airway and ably facilitate the procedures. Emergency procedures are facilitated on an as needs basis.
A close relationship exists with Otolaryngology and a combined investigation with rigid scopes is facilitated.
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Teaching and Education
Medical students from the post-graduate medical school (Southern Medical School, University of Queensland), junior medical staff training for higher qualifications in paediatrics, nursing and allied health staff in basic and post-graduate degrees all form part of the teaching areas of the department.
The service currently undertakes a comprehensive range of education and training initiatives.
| Medical students |
formal lecutres, clinical skill respiratory and sleep medicine topics, mentoring—five terms per year |
| Junior medical staff |
formal lectures, workshops, clinical skills |
| Nursing staff |
- competence based packages
- tracheostomy care
- NIV care
- polysomnography
- orientation and preceptorship
- cystic fibrosis learning package
- asthma learning package
- lectures/clinical skills—respiratory and sleep medicine topics
|
| Regional hospital medical, nursing and allied health |
- lectures/workshops on a wide range of topics
- videoconference—clinical skills for patient discharge home ventilation, bronchiectasis, cystic fibrosis etc.
- clinical videoconference round with Townsville—three per year
|
| Post-graduate medical education |
lectures/tutorials for FRACP exam candidates—weekly |
| Fellows |
- clinical skills
- pathophysiology of paediatric respiratory and sleep medicine
- polysomnography technical skills and interpretation
- lung function and exercise testing skills and interpretation
- bronchoscopy—flexible
|
| General practitioners |
lectures/workshops on a wide range of respiratory and sleep medicine topics |
| National |
- co-ordinate monthly paediatric sleep medicine videoconference clinical rounds—eight national sites, NZ and Singapore
- University of Western Australia postgrad course in paediatric sleep medicine Perth
- Sydney sleep medicine course by Prof. C. Sullivan—paediatric component
|
| Continuing professional development |
weekly postgraduate meeting, journal clubs, national and international conferences. |
| Standards of care |
development of standards of care for different groups of respiratory patient in Queensland |
| Continuing education for regional paediatric services in Qld |
dissemination of information through workshops, outreach visits, videoconference, e-health |
| Online education |
interactive online adaptation of presentations to enable reaching a wider audience and available as reference. |
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Research
The department is involved in a number of collaborative major research projects funded from sources including Smart State, Golden Casket and NHMRC. A number of these are run by the Paediatric Respiratory Research Collaboration (PI Carolyn Dakin), which also involves members from Paediatric ICU, the Department of Developmental Medicine and the Department of IT and electrical engineering (ITEE) from the University of Queensland. The chief project of this group has been a prospective cohort study of healthy babies, investigating maturational effects on sleep and sleep breathing. There are a number of projects run through the MedTecQ collaboration between the University of Queensland department of ITEE and the Respiratory and Sleep Medicine Department, on innovative telemetry techniques and improved sensors in use in polysomnography and screening investigations. Other major projects include: the development of remote sleep monitoring; cardiorespiratory monitoring in preterm infants to objectively assess respiratory status at term; Cochrane review of melatonin in sleep phase disorders and an intervention study; and audits of the management of chronic neonatal lung disease and non-invasive ventilation.
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Staff
Medical personal includes 4.5 FTE respiratory paediatricians, 0.5 developmental paediatrician, two paediatric respiratory training fellows, a paediatric registrar on four monthly rotations and a paediatric junior medical officer on a two-monthly rotation. There is close association with all units within the hospital, with direct clinical support to clinics provided by a paediatric psychiatrist and paediatric psychiatry registrar, and a general paediatrician.
The nursing staff comprise a clinical nurse consultant unit manager, six clinical nurses and ten registered nurses who co-ordinate the specialty home care patients and perform the polysomnography.
The scientific staff comprises two paediatric sleep scientists, a senior respiratory scientist and a biomedical engineer.
There are five administrative personnel who support the unit.
Close association exists with the Allied Health department with dedicated time allocated from physiotherapy, social work, dietetics, occupational therapy and speech pathology.
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Future
The unit will be combined with the Department of Respiratory Medicine at the Royal Children’s Hospital (Brisbane) by 2014, with the opening of the Queensland Children’s Hospital. The Queensland Children’s Hospital will be the single tertiary paediatric hospital for Queensland, combining all existing paediatric services of the 2 hospitals, with construction already commenced in November 2008.
The RCH paediatric respiratory service is of a similar size with a larger Cystic Fibrosis clinic, and greater numbers of patients with idiopathic bronchiectasis and oncology disorders. The RCH service has a strong research interest in indigenous pulmonary disease, cystic fibrosis and idiopathic bronchiectasis.
With the present population growth within the state it is expected that both units will need to increase in size prior to amalgamation to maintain the present service commitments. The development of co-ordinated statewide services for respiratory and sleep medicine disorders to the regional areas will provide increased opportunity for patients to be cared for in their home environment.
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