TranslateWomen's and children's services
Overview
Women’s and children’s services include disciplines that manage acute and chronic health conditions in patients up to 18 years of age, and the reproductive and gynaecological care needs of women.
Delineating service system roles
The capability of each service level is based on:
- Clinical capability required to diagnose, treat and manage relevant health conditions.
- Availability of, and access to, clinical support services to support delivery of care.
Service requirements
Women’s and children’s services are provided in inpatient and community settings. Models of care for delivery of health services described in the RDF, and the setting within which services are delivered (inpatient / community) are determined by individual health services.
This framework
The following women’s and children’s services are included in this section of the RDF:
Services
Maternity services provide care for mother and baby along the continuum of care. This includes during pregnancy, during labour and birth, and during the immediate postnatal period. The scope of this Framework describes the service, its requirements and the minimum staffing needs and clinical support services required within each level. Safety in the provision of maternity care depends upon appropriate consultation and / or referral and transfer of patients consistent with well-defined clinical pathways. This framework is consistent with the National Maternity Services Framework.
| Level | Service Description | Service Requirements | Workforce Requirements |
|---|---|---|---|
| 1 |
Provides antenatal and/or postnatal care for women with uncomplicated pregnancy. No planned birthing services but the service must be able to provide emergency care to women and neonates if unplanned birthing occurs. |
Service capability includes screening and assessment for risk factors in pregnancy including mental health problems and alcohol and other drugs use. Identifies and supports higher level services in the management of chronic conditions in pregnancy including persistent pain, diabetes and hypertension. Emergency resuscitation equipment (adult and neonate). Access to pathology and medical imaging services. Access to specialist obstetric services via telehealth. |
Registered midwives or RN with access to midwifery support where registered midwives are not available. Access to registered medical practitioner. Access to an obstetrician via telehealth. Access to allied health professionals including physiotherapy, social work, continence, dietetics, speech pathology, occupational therapy, audiology and exercise physiology. Access to oral health services. Access to Child and Family Health nurses and perinatal mental health services. Access to Child Protection and Child Health and Parenting Services. Access to lactation consultants. Access to Aboriginal Liaison Officers and Refugee Health Liaison Officers. |
| 2 |
As for Level 1 plus: Provides antenatal and postnatal care for women with uncomplicated pregnancy and may also provide low risk intrapartum care for 37 weeks gestation or more. May accept back transfer of physiologically stable women and neonates from a higher-level maternity service, following midwifery/ obstetric consultation. Provides referral to a higher-level service for lower segment caesarean section (LSCS). |
As for Level 1 plus: Dedicated birthing rooms for planned vaginal births for gestation of 37 weeks gestation or more. Antenatal cardiotocograph (CTG) monitoring with access to remote assessment and interpretation. Access to consultation from higher level maternity services within the network face to face or via telehealth. On-site Level 3 or above neonatology service. Protocols in place for immediate retrieval and transfer to higher level maternity and / or neonatology service if required. |
As for level 1 plus: Registered midwives available 24 hours. 24-hour on-site access to a DRANZCOG registered medical practitioner who is able to attend within 30 minutes. |
| 3 |
As for Level 2 plus: Provides services for low risk planned births for women 37 weeks gestation or more where the mother and baby have uncomplicated care needs. |
As for Level 2 plus: Service can perform continuous electronic fetal monitoring in labour where clinically indicated. On-site facilities for emergency delivery (abdominal or vaginal). Able to support induction of labour following 39 completed weeks of pregnancy. Able to perform elective caesarean section at >39 weeks gestation. Formal linkages with higher level maternity services within the network. |
As for Level 2 plus: 24-hour access to a registered medical practitioner with credentials in anaesthetics who can attend within 30 minutes. 24-hour access to a registered medical practitioner credentialed to provide care to the neonate and who can attend within 30 minutes. |
| 4 |
As for Level 3 plus: Provides intrapartum care for low and moderately complex mothers and babies with pregnancy > 34 weeks gestation. In utero transfer of neonates should be undertaken where there is a risk of delivery below the 34-week gestation threshold when this is clinically and logistically possible. When this is not possible and the neonate is close to the transfer criteria threshold, clinical discretion should be applied to the decision to transfer dependent on the condition of the neonate, in consultation with a qualified neonatologist and the Level 5 or Level 6 maternity and neonatology service as appropriate. |
As for Level 3 plus: 24-hour on-site access to fetal scalp pH or lactate sampling. Access to on-site urgent blood and specimen testing, blood and volume expanders. Blood storage facilities on-site and cross-matched blood readily available. Access on-site to 24-hour ultrasound services. Access to consultation from higher level maternity services within the network face to face or via telehealth. Provides training of specialist obstetricians and midwives. On-site Level 4 neonatology Service. Access to Level 4 or above ICU/HDU services within the network. Access to genetics service in the network. |
As for Level 3 plus: Appointed FRANZCOG (or equivalent) registered medical specialist with credentials in obstetrics on-call 24 hours and who can attend within 30 minutes. Nominated obstetric clinical leader for the service. Obstetric registrars and RMOs. On-site specialist anaesthetist on-call 24 hours and able to attend within 30 minutes. On-site specialist paediatrician with experience in neonatal care on-call 24 hours and able to attend within 30 minutes. Medical officer on-site 24 hours. Registered midwives on-site 24 hours. Specialist nursing available onsite for continence, lactation and diabetes nurse educators. Specialist allied health professionals including physiotherapy and social work. Access to perinatal mental health professionals able to provide perinatal mental health assessment and support for perinatal loss. Nominated midwifery clinical leader. Access to a midwifery educator. Access to a clinical pharmacist. |
| 5 |
As for Level 4 plus: Provides intrapartum care for low, moderate and high complexity mothers and babies with gestation >32 weeks gestation. This service is a multidisciplinary service with the capacity to manage all unexpected pregnancy and neonatal emergency presentations. In utero transfer of neonates should be undertaken where there is a risk of delivery below the 32-week threshold when this is clinically and logistically possible. When this is not possible and the neonate is close to the transfer criteria threshold, clinical discretion should be applied to the decision to transfer dependent on the condition of the neonate, in consultation with a qualified neonatologist and the Level 6 Maternity and Level 6 Neonatology service. |
As for Level 4 plus: A full range of antenatal, birthing and postnatal care facilities, including dedicated birth suites, an antenatal day assessment unit, allocated inpatient beds within a maternity unit and dedicated maternity beds for the acute care of high-acuity patients. On-site Level 5 Neonatology Service. On-site Level 4 or above General Surgery Service. Access to interventional radiology and vascular services within the network. |
As for Level 4 plus: Clinical lead roles in obstetrics, midwifery, nursing and neonatology. Obstetric registrars and RMOs. Paediatrics registrars and RMOs. Anaesthetics registrars and RMOs. Specialist nursing part of multidisciplinary maternity services team (continence, lactation and diabetes nurse educators). WACS specialist allied health part of multidisciplinary maternity team (physiotherapy, occupational therapy, psychology, social work, dietetics). Endocrinologist part of multidisciplinary maternity team. Access to psychiatry (general and perinatal) and addiction medicine specialists. |
| 6 |
As for Level 5 plus: Provides all levels of care, including the highest level of complex care for women with serious obstetric and fetal conditions that require high-level multidisciplinary care. A Level 6 service provides clinical advice and support by a consultant registered medical specialist credentialed in obstetrics 24 hours. |
As for Level 5 plus:
Vascular surgery and interventional radiology services. Support and statewide clinical leadership provided to lower-level services. |
As for Level 5 plus: Specialist neonatologists on-call 24 hours. 24-hour on-site access to consultant-level medical imaging, paediatrics, anaesthetics and adult ICU staff. Clinical pharmacist on-site. |
Neonatology services provide a range of care from well infant care to highly specialised care, for sick, low birth weight and/or premature infants, and/or infants born with congenital or other conditions. The scope of this Framework describes the service, its requirements and the minimum staffing needs and clinical support services required within each level. Safety in the provision of neonatal care is depends upon appropriate consultation and / or referral and transfer of patients consistent with well-defined clinical pathways. The proposed framework is consistent with the National Maternity Services Framework.
| Level | Service Description | Service Requirements | Workforce Requirements |
|---|---|---|---|
| 1 |
n/a |
n/a |
n/a |
| 2 |
n/a |
n/a |
n/a |
| 3 |
Provides immediate newborn care for low-risk infants greater than 37 weeks gestation and with a birth weight greater than 2500 grams. |
Neonatal resuscitation equipment and resources available. Provides phototherapy and controlled oxygen therapy in consultation with a higher-level neonatology service. Can initiate intravenous therapy pending transfer to a higher-level service. Protocols in place for emergency transfer to higher level service if required. |
24-hour on-site access to a health professional with qualifications and skills in initiating neonatal resuscitation. On-site medical practitioner with credentials in advanced neonatal resuscitation and the necessary skills in post-resuscitation assessment, stabilisation and potential referral for emergency retrieval to a centre at a higher service level. Medical practitioner should be on-call 24 hours and available within 30 minutes of hospital. Access to allied health professionals including physiotherapy, social work, dietitians, speech pathology, psychology, occupational therapy and audiology. |
| 4 |
As for Level 3 plus: Provides immediate newborn care for infants greater than or equal to 34 weeks where the mother has no identified risk factors or complex care needs. |
As for Level 3 plus: Advanced neonatal life support capability. Capacity to commence mechanical ventilation in consultation with a higher-level neonatal service pending transfer to a higher-level neonatology service. On-site neonatal facilities for apnoea monitoring, low level oxygen therapy (including monitoring) and nasal/orogastric feeding in consultation with higher level neonatal service. Capacity to initiate and maintain intravenous therapy in consultation with higher level neonatal service. |
As for Level 3 plus: On-site paediatrician with experience in neonatology on-call 24 hours. Specialist allied health professionals including dietetics, physiotherapy, social work and speech pathology services. Access to a lactation consultant. RNs with appropriate post graduate qualifications and/or experience in neonatal nursing; RNs may be supported by ENs in providing care. Access to RNs with appropriate post graduate qualifications and/or experience in neonatal nursing; RNs may be supported by ENs in providing care. Access to outreach, community or outpatient allied health professionals (dietetics, physiotherapy, social work, neuropsychology, occupational therapy). Access to perinatal mental health services in the network. |
| 5 |
As for Level 4 plus: Provides services for neonates greater than or equal to 32 weeks gestational age, including neonates with risk factors and / or complex care needs. |
As for Level 4 plus: Special care nursery beds. Provision of short-term mechanical ventilation (<6 hours) pending transfer. Nasal CPAP (continuous positive airway pressure) / humidified high flow nasal cannula (HHFNC) oxygen with access to arterial blood gas, pathology and radiology. Non-invasive BP (blood pressure) monitoring. Receives transfers from lower-level services and back transfer from higher-level neonatology services. |
As for Level 4 plus: Neonatal nursing staff to provide back-transfer support, local education and training. Consultant paediatrician with scope of practice including neonatology. On-site paediatrics registrar on-call 24 hours. Specialist neonatology allied health providers available extended hours including physiotherapy, social work. Specialist allied health professionals in occupational therapy, dietetics, speech pathology. Clinical pharmacist on-site. |
| 6 |
As for Level 5 plus: Provides comprehensive multidisciplinary care for newborns with highly complex care needs, including those less than 32 weeks gestation, and infants with congenital and / or metabolic diseases of the newborn. Support women with pregnancies with known fetal abnormalities requiring consultation, treatment or surgery immediately post birth. |
As for Level 5 plus: Capacity to provide medium to long-term mechanical ventilation and life support. Point of care laboratory equipment available within the nursery area. On-site 24-hour access to neonatal echocardiography, cranial USS and MRI services. Consultation-liaison and statewide leadership role for lower-level neonatology services. On-site neonatal emergency transport team on-call 24 hours. Active participation in clinical trials, research and specialist training. |
As for Level 5 plus: On-site specialist neonatologists on-call 24 hours. Advanced trainees in neonatology. Neonatology registrars/RMOs. Specialist nursing positions including neonatal intensive care nurse educators and intensive care equipment nurse. RNs with post graduate qualifications and/or experience in neonatal intensive/critical care nursing on-site 24 hours. Specialist neonatal pharmacist on-site. |
The treatment of children and adolescents with cancer comes with a high degree of risk. Treatment modalities can be prolonged and complicated with narrow therapeutic margins. The side effects of treatment can be severe including acute organ toxicities, immunodeficiency, and infection.
The rarity and complexity of child and adolescent cancer is a challenge for health services. Specialised care is required for diagnosis, treatment, post-treatment surveillance and long-term follow up care. Paediatric cancer services also need to meet the needs of children, using a family-centres model of care in an environment that is safe and appropriate for children and adolescents.
In recognition of the highly specialised needs of children and adolescents with cancer, Tasmania has a shared-care cancer services model, with support from specialist tertiary paediatric referral centres located interstate.
| Level | Service Description | Service Requirements | Workforce Requirements |
|---|---|---|---|
| 1 |
n/a |
n/a |
n/a |
| 2 |
n/a |
n/a |
n/a |
| 3 |
n/a |
n/a |
n/a |
| 4 |
Provides a shared care service that delivers supportive care to children and adolescents with cancer. Communication and consultation with a Level 5 or 6 service for all pre-diagnosis tests and investigations undertaken. Definitive diagnosis, staging and/or risk assessment is provided at a Level 5 or 6 service. May provide a low-complexity day case paediatric chemotherapy service, under the guidance of a Level 5 or 6 service. Provides supportive care measures for patients and their families under the guidance of a Level 5 or 6 service. Provides limited tests investigations and appointments in collaboration with a Level 5 or 6 service during surveillance or long term follow up post treatment. |
Dedicated paediatric ward with an appropriate isolation room for caring for an immunocompromised child. Dedicated paediatric ambulatory department with capacity to deliver low-complexity chemotherapy and supportive care services for children and adolescents with cancer. Area available to host regional outreach paediatric oncology clinics. On site access to an emergency department with paediatric trauma and resuscitation facilities with the ability to stablise acutely unwell children or adolescents, with appropriate escalation and transfer guidelines to a level 5 or 6 service. Onsite and immediate availability of staff competent in accessing a central venous access device to ensure timely administration of fluid, blood products, antibiotics and other life-saving interventions. Documented process for inter-hospital transfer of acutely unwell patients to a level 5 or 6 paediatric intensive care. Access to electronic pathology, radiology and hospital records, and systems in place to support the communication of shared paediatric oncology care across services (telehealth, videoconferencing). On site access to laboratory services for managing supportive care and surveillance. Access to paediatric radiologists, and radiographers with paediatric experience. Access to a paediatric palliative care service, pain management services, and child and youth mental health services. Onsite access to anaesthetic services to deliver interventions in real time to infants or younger children. Child and family-friendly inpatient and outpatient environment in line with the Royal Australasian College of Physician Standards of care for children and adolescents in health services. |
A paediatrician as medical head of the department. A consultant paediatrician on-site and on-call 24 hours. Paediatrics registrar on-site and on-call 24 hours. Anaesthetics registrar on-site 24 hours. Access to radiologist credentialled in paediatrics 24 hours. CNC in paediatrics. RNs with specialised skills in paediatrics allocated to outpatient and inpatient areas 24 hours. Chemotherapy competency for all nursing staff involved in the administration of chemotherapy. RNs with central venous access management competency on each shift. Access (on site, visiting or tele-medicine) to registered nurse(s) with specialised knowledge and experience in paediatric oncology at Level 5 or 6 services. A designated clinical pharmacist specialising in paediatrics or haematology/oncology available on-site during business hours. Access to an on-call pharmacist after hours. Pharmacists and pharmacy staff competent in the manufacture of sterile medicines, chemotherapy and biological agents, available during hours and on-call after-hours. Access on site to allied health services for children including speech pathology, occupational therapy, physiotherapy, dietetics, and social work. |
| 5 |
As for Level 4 plus: Provides comprehensive care to children and adolescents with cancer with direct links to a Level 6 service. Provides a combination of ambulatory, inpatient and multidisciplinary care, and has access to Level 6 sub-specialty services. Provides diagnostic services and/or management to new patients. Provision of, or timely referral pathways for all tests and investigations to complete the definitive diagnosis and risk assessment of all malignancies in children and adolescents, including participation at diagnosis with a centralised multidisciplinary meeting hosted by a Level 6 service. Provision of, or timely referral pathways for all therapeutic interventions in the management of paediatric cancer including chemotherapy, biotherapy, radiotherapy and surgery in both the inpatient and outpatient setting. Enrolment and co-ordination of paediatric oncology patients in clinical trials. Provides all supportive care measures along the treatment pathway for patients and their families. A shared care collaborative model with a Level 6 service is used for:
Provides all surveillance tests, investigations and appointments according to relevant protocol and, for children following HSCT, in collaboration with a Level 6 service. Adolescents with ‘adult-type’ malignancies should have links or advice from adult oncology and the relevant multidisciplinary team, where appropriate. |
As for Level 4 plus: Dedicated paediatric oncology ward environment with appropriate facilities to provide sufficient isolation of patients from airborne pathogens (such as HEPA filtration and positive/negative pressure rooms), delivering comprehensive paediatric cancer care. Dedicated paediatric oncology outpatient clinics with the capacity to deliver comprehensive chemotherapy and supportive care. Dedicated procedure rooms and isolation rooms for managing infectious ambulatory patients within an identified waiting area located away from the general population. On site access to paediatric emergency department zone with paediatric resuscitation facilities and the ability to stablise acutely unwell children or adolescents. Onsite and immediate availability of staff competent in accessing a central venous access device to ensure timely administration of fluid, blood products, antibiotics and other life-saving interventions. Paediatric intensive care unit providing comprehensive care including complex multi-system life support for an indefinite period to children younger than 18 years of age in line with the College of Intensive Care Medicine minimum standards. Established referral pathways for the shared care of children undergoing surveillance with other level centres. Data systems integrated with relevant cancer registries and clinical trial partners to facilitate information sharing. Access to suitable accommodation options for caregivers available within or close to the institution. Onsite access to the diagnostic testing, clinical and consultative laboratory services required to deliver paediatric oncology care. Access to medical imaging services that includes a paediatric radiologist and anaesthetist. Clinical pharmacy services provided to inpatient and outpatient settings including specialist paediatric oncology pharmcist(s). On-site 24-hour access to Level 5 or 6 pharmacy services including patient-specific manufacture of, sterile products, parenteral nutrition, chemotherapy, and biological therapy, in a TGA registered facility or in a compounding facility that is compliant with Good Manufacturing Practice (GMP). Oncology clinical trials pharmacy service. Access to specialist pharmacist medicines information. |
As for Level 4 plus: Specialist paediatrician with credentials in oncology on-site and on-call 24 hours. Access to specialist paediatric oncologist on-site or via telehealth 24 hours. Consultant anaesthetist credentialled in paediatrics on-site and on-call 24 hours. Anaesthetic registrar on site 24 hours. Paediatric radiologist available on-site during business hours and on-call 24 hours a day. Access to radiation oncologist. On-site access to specialist paediatric surgical services. Access to consultant paediatric subspecialty physicians on-site or via telehealth including neurology, cardiology, nephrology, respiratory, endocrinology, genetics, infectious diseases, haematology and immunology. On-site access to dentist. On-site paediatric oncology care co-ordinators. Access to an experience paediatric nursing staff with skills in oncology and paediatric surgery. Pharmacist with specialist skills in paediatric oncology for inpatients and ambulatory patients, accessible during business hours and via the on-call pharmacist after hours. Clinical trials pharmacist available during business hours and via the on-call pharmacist after hours. On site access to paediatric specific allied health services including social work, occupational therapy, speech pathology, dietetics and physiotherapy. On site access on site to staff able to teach and deliver procedural pain management strategies. Access to paediatric psychologist responsible for providing mental health services to children and adolescents with cancer and their families.
|
| 6 |
As for level 5 plus: Coordinates paediatric oncology care with Level 4 and 5 children’s cancer services. Coordinates comprehensive, multidisciplinary cancer planning, including convening meetings to discuss all new malignant cancer diagnoses and, as necessary, across critical time points in their care as requires, across all service levels. Assesses and manages risk in new therapies and supportive care interventions. Provides a comprehensive paediatric chemotherapy and biotherapy service to meet the demands or all treatment plans across all paediatric oncology diagnoses, as well as introducing new therapies where indicated. Provides a paediatric haematopoetic stem cell transplant service. Enrolment and co-ordination of paediatric oncology patients in clinical trials including phase 1 and 2 clinical trials. Provides all tests, investigations and appointments according to the respective protocol delivery map for all paediatric malignancies and following HSCT. |
As for Level 5 plus: Paediatric emergency department. Paediatric cancer wards with negative pressure rooms. Separate waiting areas within paediatric oncology outpatient department, located away from the general waiting area for patients following a bone marrow transplant. |
As for level 5 plus: Access to a radiation oncologist 24 hours. Access to radiation oncologist with paediatric subspecialty on-site or via telehealth. Paediatric HSCT specialty consultant available on-call 24 hours a day. Paediatric anaestheic consultant and registrar on-site. Paediatric nursing staff across all shifts in the inpatient setting with demonstrated paediatric chemotherapy and HSCT nursing competence. Nurse navigators in most paediatric cancer streams. Specialist paediatric oncology pharmacist with knowledge/experience of paediatric HSCT. Paediatric allied health professionals part of multidisciplinary team including social work, occupational therapy, speech pathology, dietetics and physiotherapy. |
Children's radiation oncology
Radiation therapy is an important therapy for cancers in children. This type of therapy is used either alone or combined with surgery, chemotherapy and newer biological therapies in the curative or palliative treatment of cancer. Radiation therapy also has a palliative role for metastatic and locally recurrent disease.
In addition to the radiation oncology requirements for adults, services for children require:
- Age- and family-appropriate facilities and supporting infrastructure
- Close integration with children’s oncology services, diagnostic services (including high-quality Medical Imaging Services), and allied health and Palliative Care Services
- Utilisation of a Paediatric Haematology / Oncology Network to enhance seamless delivery of cancer services and manage / reduce risks of gaps in treatment
- Access to children’s rehabilitation and psychosocial support services (including psychology / psychiatry, social work and welfare)
- Access to appropriate children’s allied health professional specialties, particularly occupational therapy for preparation of children to reduce the need for a general anaesthetic (e.g. use of a mock radiotherapy machine)
- Documented processes to manage children’s emergencies within an adult environment
- Documented processes with community support services.
| Level | Service Description | Service Requirements | Workforce Requirements |
|---|---|---|---|
| 1 |
NA |
NA |
NA |
| 2 |
NA |
NA |
NA |
| 3 |
NA |
NA |
NA |
| 4 |
NA |
NA |
NA |
| 5 |
Delivers a full suite of radiation oncology services for children, including consultative services and treatment. May provide a short course of palliative radiation therapy for symptom relief at a Level 5 (adult) radiation oncology service under supervision of Level 6 service specialising in children’s services. Ideally provides day-stay, children-specific beds. May provide external beam therapy. |
Provides limited range of radiation oncology treatment services in accordance with standardised, evidence-based guidelines and protocols, as appropriate. Inclusion in a service network with higher level services, ensuring access to information related to latest evidence-based care and treatments. On-site access to paediatric anaesthetics services. On-site (or documented process for) access to level 5 medical imaging, pharmacy, nuclear medicine, palliative care. |
Registered medical specialist with credentials in children’s services and interest in oncology for patient supervision. Medical practitioners competent in providing advanced paediatric life support. 24-hour access to registered medical specialist with credentials in radiation oncology, for consultation and for children admitted with complications. Radiation therapists to meet planning and treatment capacity requirements and clinical need. Adequate numbers of qualified radiation oncology medical physicists (or equivalent support) on-site during business hours and accessible after hours, as required. Allied health professionals who have access to specialty allied health professionals within Level 6 service who have expertise in management of children undergoing radiation therapy. Access (including visiting or remote) to Specialist Clinical Pharmacists Oncology/Haematology. Access to Specialist Pharmacist Drug Information.
|
| 6 |
As for Level 5 plus: Provides comprehensive range of specialised radiation oncology treatment services, including total body irradiation and external beam and brachytherapy services. Provides treatment for rare tumours, delivered by highly skilled, multidisciplinary workforce. Provides support to statewide mortality and morbidity meetings, and has critical mass of expertise or recognised volume of work to ensure quality care. Patients cared for by highly skilled, multidisciplinary care team with core members capable of providing full range of management and support, with core multidisciplinary members usually including registered medical specialists with credentials in subspecialties, including children’s surgery and children’s oncology; registered medical specialists with credentials in radiation oncology, radiology and pathology; and registered nurses and allied health professionals expert in care of children and their families. Participates in multidisciplinary clinic, ensuring the child’s cancer is staged and appropriate evidence-based treatment recommendations are recorded. |
As for Level 5 plus: All clinical staff trained in advanced paediatric life support. Appropriate linear accelerator bunker and equipment to deliver total body irradiation and total skin electron beam therapy. Appropriate inverse planning system and independent Intensity Modulated Radiation Therapy dose verification system. Provision of appropriate anaesthetic equipment and expertise where anaesthetic procedures undertaken. Fully integrated, computer-assisted, networked planning and treatment system with capability for verifying precision, planning and treatment modalities. Capacity for safe delivery of sealed and unsealed radioisotopes or radiopharmaceuticals. Appropriate facilities for children’s anaesthetics with induction rooms and recovery area 24 hour/s. Support areas (consulting rooms and offices) collocated with radiotherapy service. In preparation for radiation therapy, a room available for education of children, which may include mock radiotherapy machine. Facilities available for specialised procedures. On-site (or documented processes for) access to Level 6 nuclear medicine and palliative care services. Documented processes for subspecialist children’s services (including process to manage children’s emergencies within adult environment). Documented processes for adolescent and young adult specialty services if available. |
As for Level 5 plus: Registered medical specialist with credentials in radiation oncology and special interest in children’s services to develop and supervise treatment regimes in consultation with registered medical specialist with credentials in children’s oncology. 24-hour access to registered medical practitioner with credentials in radiation oncology for inpatients. Access to radiation oncology staff with special interest in children’s radiation services (e.g., total body irradiation, stereotactic radiosurgery, stereotactic radiotherapy and brachytherapy). Allied health professionals part of multidisciplinary radiation oncology team including occupational therapy, dental, speech pathology and dietetics). |
Gynaecology is the branch of medicine that deals with the treatment of diseases of the female reproductive system.
| Level | Service Description | Service Requirements | Workforce Requirements |
|---|---|---|---|
| 1 |
n/a |
n/a |
n/a |
| 2 |
n/a |
n/a |
n/a |
| 3 |
A Level 3 service performs minor gynaecological procedures on low-risk patients by an appropriately trained and credentialed clinician. There are no inpatient services provided at this level. |
Provides clinic-based gynaecological procedures. No inpatient gynaecology beds at this level. Access to specialty outpatient allied health programs. |
Appropriately trained and credentialed gynaecology clinician. May have access to visiting gynaecologists or via telehealth. Access to allied health services including physiotherapy, social work, dietitians, psychology, and occupational therapy. |
| 4 |
As for Level 3 plus: Performs gynaecological assessment and surgical management of low and moderate risk gynaecology patients. |
As for Level 3 plus: Access to an emergency theatre on a 24-hour basis. Inpatient surgical beds for gynaecology patients. At least one operating/procedure room with separate recovery area/room for post-operative care. Network links with specialist gynaecological oncology, medical oncology, radiation oncology and palliative care services. May provide specialty training in gynaecology. Pre- and post-surgical allied health pathways, including surgical diversion pathways. |
As for Level 3 plus: Gynaecologist available 24 hours. RNs with appropriate post graduate qualifications and/or experience in peri-operative nursing. Specialist physiotherapy professionals (women’s health, pelvic pain, continence, prolapse). Access to clinical pharmacist. |
| 5 |
As for Level 4 plus: Capability to manage a broad range of patients in association with other specialists, with appropriate formal links and referrals in place with higher level gynaecology services for certain complex cases. |
As for Level 4 plus: Inpatient surgical ward area for gynaecology patients. Outpatient services that provide office-based gynaecological procedures (colposcopy, hysteroscopy). Multidisciplinary models of care including specialty outpatient allied health programs for patients with specific gynaecological care needs (pelvic pain, continence, prolapse). |
As for Level 4 plus: Gynaecology registrar available 24 hours. RNs with appropriate post graduate qualifications and/or experience in gynaecological nursing. CNC providing leadership in gynaecological care. Specialist continence nursing. On-site persistent pain multidisciplinary team. Clinical pharmacist on-site. |
| 6 |
As for Level 5 plus: Manages complex cases in association with specialists in reproductive endocrinology, infertility, and gynaecological malignancy. |
As for Level 5 plus: Gynaecologic oncology multidisciplinary team with representation from medical oncology, radiation oncology, and gynaecological oncology. Provides sub-specialist gynaecologic oncology consultation and outreach services to lower-level services. Dedicated women's ward. Ability to accept referrals for complex cases from lower-level services. |
As for Level 5 plus: On-site gynaecological oncologist. On-site gynaecological registrar with gynaecological oncology responsibilities. On-site gynaecologists with sub-specialty interest in uro-gynaecology, minimally invasive surgery and reproductive endocrinology. CNC providing leadership in gynaecologic oncology. Designated gynaecological cancer care coordinators. |
Child and Family Services
A Child and Family Health service provides early and ongoing engagement with children and families from birth until the age of 5 years. Services are designed to support every child to achieve optimal health and developmental outcomes in early childhood, to reduce inequities and to improve the long-term health and wellbeing of the Tasmanian population.
Support offered includes growth and developmental surveillance and screening, infant feeding support, behaviour management, sleep and settling advice and perinatal mental health screening and health promotion. Support is tailored to enhance parental confidence and capability through providing information and service focused on enhancing relationships between children and parents.
| Level | Service Description | Service Requirements | Workforce Requirements |
|---|---|---|---|
| 1 |
A Level 1 service provides community-based healthcare services for clients as part of an approved schedule of health service provision. Delivered by Child and Family Health Nurses. |
Clinical governance of service provided by community health service delivering care. Service delivered in collaboration with inpatient Women’s and Children’s Services (including Maternity, Neonatology and Paediatric), patient’s usual GP and other community based services. Service has access to oral health services, perinatal mental health services. women’s and children’s services, lactation consultants and child protection services. Service includes early identification of family need, child health and developmental screening and surveillance (including broad family assessment and family violence consideration), comprehensive child health assessments, health promotion and education, perinatal transition and wellness, group programs, and referral pathways for identified need. Service modalities at this level include face to face consultations, group service provision, home visiting (initial appointment) and telehealth. Services provided from dedicated Child Health Centres, THS Community Health Centres, DoE Child and Family Learning Centres, Local Council facilities and Medical Centres. Access to vehicles to support home visiting, clinic spaces designed to support the delivery of Child Health specific services and appropriate IT infrastructure to support utilisation of CHaPS Electronic Health Record to underpin care delivery. Data management systems to enable service delivery data, client follow up and management of referrals. |
Registered Nurses - Child and Family Health Nurses (CFHN) (hold a Graduate Certificate or Graduate Diploma, Child and Family Health Nursing). Registered Midwives where CFHN’s not available. Access to social work and psychology, speech pathology, occupational therapy and audiology. Access to lactation consultants. |
| 2 |
As for Level 1 plus: Provides additional support following identification of additional client specific needs. Delivered by Child and Family Health Nurses supported by Allied Health Staff. |
As for Level 1 plus: Care delivered for a defined short-term period and includes goals based supported through defined care planning and case management. Service provides enhanced early intervention support to address a need that cannot be met by universal service provision alone. Service capability includes supporting families through transition to parenthood including facilitating access to programs that build on emotional health, resilience, and coping. Service provides perinatal mental health services for clients not requiring referral to specialist perinatal mental health service. Service has access to Statewide Mental Health Services including Child and Adolescent Mental Health Service and THS Perinatal Mental Health Service. Service has access to Woman’s and Children’s Services including paediatric and neonatal clinics and specialist paediatric allied health services. |
As for Level 1 plus: Dedicated Allied Health staff employed through CHaPS. Social work, psychology, speech pathology, occupational therapy and audiology may be part of care team. |
| 3 |
As for Level 2 plus: Provides services at a more intensive level of support (moderate complexity) and coordination based on assessment of family needs. Care may be delivered for up to 2 years as defined by family need. Care delivered by Family and Child Health Nurses and Allied Health Staff. |
As for Level 2 plus: Service provision includes home visiting program for vulnerable families. Service provision includes interventions focusing on infant wellbeing, building parental confidence and skills development. Services are delivered either in the client’s home or clinic location in a flexible and sustained way to meet family need. Outcomes are focused on enhancing child development, wellbeing and health outcomes with strengthened relationships between infants, children and their parents. |
As for Level 2 plus: Program support, oversight and coordination provided by Grade 5,6 or 7 Registered Nurses. Social work, psychology, speech pathology, occupational therapy and audiology part of care team. Allied health assistants. |
| 4 |
Provides care for families with more complex needs. Care delivery defined in collaboration with services provided from other agencies within the scope of CHaPS universal service delivery. Care delivered by Child and Family Health Nurses, Child Safety Staff, Allied Health Staff, General Practitioners and potentially other specialists. |
As for Level 3 plus: Service provision encompasses care for families that are part of a case management arrangement with a lead agency (e.g., child safety, intensive family support services, mental health services, paediatric, allied health or medical teams). Child and Family Health Nurses may attend the Child Safety care planning/case review meetings or other meetings arranged by the lead agency to provide clinical information/advice about child health service provision. |
As for Level 3. |
| 5 |
NA |
NA |
NA |
| 6 |
NA |
NA |
NA |
Youth health services
Youth health services are delivered in a variety of community settings, including child health clinics, multipurpose health clinics, schools and home-based care.
| Level | Service Description | Service Requirements | Workforce Requirements |
|---|---|---|---|
| 1 |
NA |
NA |
NA |
| 2 |
NA |
NA |
NA |
| 3 |
Limited range of community and / or hospital services for youth/adolescents/young people aged between 12 and 24 years. |
Service facilitates referral to specialist youth health services such as transition support for young people with chronic illness. Service has access to:
|
Nursing and / or allied health professionals trained in assessment, care and management and delivery of youth health programs and services. Medical practitioner and RN available 24 hours where inpatient services are provided. Aboriginal and Torres Strait Islander Health Worker if applicable to service scope. May have youth worker. |
| 4 |
As for Level 3 plus: Provides assessment, treatment, counselling, information, education and prevention programs designed specifically for young people. |
As for Level 3 plus: Service scope may include:
|
Community paediatrician. Allied health professionals including physiotherapy, occupational therapy, social work, psychology, speech pathology and dietetics. |
| 5 |
As for Level 3 plus: Provide youth specific service in both hospital and community settings. Supports transitions of care for chronically ill adolescents. Services include targeted health education programs; referral, assessment and treatment services; intensive family intervention; case coordination. |
As for Level 4 plus: Paediatric inpatient unit with adolescent area available. Active planning for transition for adolescents/ young adults with long term conditions which may include development of a self-management plan and regular review where appropriate. Service scope may include:
|
As for Level 4 plus: Paediatrician and physician in general medicine available 24 hours. Child and adolescent psychiatrist available for consultation and liaison. Allied health professionals with specific paediatric caseload including occupational therapy, social work, clinical psychology. Specialist clinical pharmacist (paediatrics). Youth health coordinator / youth health services manager. |
| 6 |
As for Level 5 plus: Provides adolescent medicine consultation for inpatients. Provides outpatient shared care model for specialty clinics. Provides consultancy service for specific target groups such as chronically ill, terminally ill, sexual assault and physical abuse victims, people with intellectual disability. Provides extended hours and crisis intervention services. |
As for Level 5 plus: Provide networked support to lower level youth health services. Support services for inpatient care as for Level 5 or higher paediatric medicine. Service supports provision of inter-disciplinary service responses for youth with complex care needs where a comprehensive, specialised response is required. |
As for Level 5 plus: Medical officer in adolescent medicine. Medical officer in child and adolescent psychiatry. Allied health professional with specialist skills in youth health (dietetics, physiotherapy, occupational therapy, clinical psychology, social work). |
Paediatrics and surgery for children
Paediatrics is a medical specialty that manages medical conditions affecting babies, children and young people. Additional services relating to paediatric and childrens surgery included in this section of the RDF:
Community paediatrics services are delivered in a variety of community settings, including outpatients, child health clinics, multipurpose health clinics, schools and home-based care.
| Level | Service Description | Service Requirements | Workforce Requirements |
|---|---|---|---|
| 1 |
n/a |
n/a |
n/a |
| 2 |
Provides care to paediatric patients to promote their development, protection and wellbeing. |
Services may include:
|
Registered nurse and/or registered midwife, nurse practitioner, Aboriginal and Torres Strait Islander Health Worker and / or allied health professionals operating in interdisciplinary care model. |
| 3 |
Provides ambulatory care for paediatric patients, including patients with minor medical conditions. |
As for Level 2 plus: Service capable of providing limited treatment for minor injuries and illnesses, basic life support and limited stabilisation prior to transfer to higher- level of service. Service scope may include:
|
As for Level 2 plus: Registered medical practitioner with skills / experience in primary care. RNs with appropriate post graduate qualifications and/or experience in paediatrics. Access to allied health professionals including physiotherapy, social work, dietetics, speech pathology, psychology, occupational therapy and audiology. |
| 4 |
As for Level 3 plus: Provides short- to long-term or intermittent non-admitted care to low and moderate risk/complexity paediatric patients. Delivered by medical, nursing and / or allied health professionals. |
As for Level 3 plus: Service scope includes:
|
As for Level 3 plus: On-site community paediatricians. Specialist allied health professionals including physiotherapy, occupational therapy, social work, psychology, speech pathology, audiology and dietetics. |
| 5 |
As for Level 4 plus: Provides short-term or intermittent non-admitted care for low to high risk/complexity paediatric patients. Delivered by multidisciplinary team of specialist paediatric medical, nursing, and allied health professionals. |
As for Level 4 plus: May provide some programs or interventions over extended hours. Service provision includes:
Service scope may include:
Service has access to:
|
As for Level 4 plus: Allied health professionals with specific paediatric caseload including physiotherapy, occupational therapy, social work, psychology, speech pathology and dietetics. Access to OPST and audiology.
|
| 6 |
As for Level 5 plus: Provides short- to long-term or intermittent non-admitted care to highest risk/complexity paediatric patients. |
As for Level 5 plus: Service provision includes specialised interventions for clients with highly complex care needs and/or severe comorbidities. Service supports dedicated inter-disciplinary service responses for individuals with complex care needs where a comprehensive, specialised response is required (e.g., health, child protection, youth justice). Leadership role in development and implementation of statewide clinical guidelines for children. |
As for Level 5 plus: Child and adolescent psychiatrist available. |
Paediatric medicine is a specialty area of clinical practice that manages medical conditions affecting babies, children and young people.
| Level | Service Description | Service Requirements | Workforce Requirements |
|---|---|---|---|
| 1 |
n/a |
n/a |
n/a |
| 2 |
Limited inpatient service with short-term coverage, which can provide short-term, low-risk acute care and treatment to an unwell paediatric patient. |
Capable of providing basic life support for children and provides limited stabilisation of children who require transfer to higher level of service within relevant children’s service network. |
24-hour on-site access to a health professional with qualifications and skills in paediatric resuscitation. Access to allied health services for appropriate follow-up if required including physiotherapy, social work, dietetics, speech pathology, psychology, occupational therapy and audiology. |
| 3 |
As for Level 2 plus: Provides short term inpatient care (up to 48 hours) for uncomplicated, common paediatric medical conditions. Paediatric patients may be admitted short-term for acute health and/or protection concerns (e.g., rehydration, tonsillitis, otitis media) using management protocols agreed with higher level services. |
As for Level 2 plus: Allocated bed area or bay of inpatient children’s beds available that are “paediatric safe beds”. Isolation capacity in separate rooms. Access to paediatric specific education and training for all staff. Access to child and adolescent medical services for inpatients. |
Registered medical practitioner with credentials in paediatrics available 24 hours. Registered nurses with paediatrics skills and experience. |
| 4 |
As for Level 3 plus: Provides care for paediatric patients with low to moderate levels of clinical complexity. |
As for Level 3 plus: Designated paediatric ward where children and adolescents are physically separated from adult patients. Paediatric beds within general ED. Designated close observation care area / beds managed by paediatric specialists—these may be in children’s inpatient ward or general intensive care unit. Admitted children with complex social issues or significant comorbidities must have combined care with paediatric medical team. Provides child protection assessments and referral as necessary. May provide a Hospital in the Home service. On-site education facilities. |
As for Level 3 plus: Registered medical specialist with credentials in paediatrics available 24 hours. Specialist paediatric registrars and RMOs on-site. CNC specialising in and providing leadership in paediatric care. Registered nurses with paediatrics skills and experience on-site 24 hours. Specialist allied health services including physiotherapy, social work, dietetics, speech pathology, psychology, occupational therapy and audiology. Clinical pharmacist on-site. |
| 5 |
As for Level 4 plus: Provides definitive inpatient care for paediatric patients with low to high levels of illness complexity / severity. Provide some paediatric specialist services e.g., respiratory, diabetes oncology (e.g., rehabilitation, child developmental services). |
Dedicated paediatric inpatient ward with separate adolescent area. Paediatric medical, surgical, intensive care and neonatology sub-specialty services on-site. Service may have some subspecialty paediatric disciplines. On-site designated paediatric ED zone. Designated paediatric-specific ambulatory / same day treatment area. Neonatal services provided according to separate sustainable roster. Extended hours child protection services. Dedicated consultation-liaison child psychiatry service available with dedicated child and youth mental health beds. Access to specialist paediatric mental health services. Access to level 5 or above community paediatrics service. |
As for Level 4 plus: Paediatric registrar on-site 24 hours. On-site paediatric surgeons and specialist paediatric anaesthetist. On-call paediatric surgical and ICU specialists available 24 hours. Paediatric surgical, anaesthetics, intensive care, neonatology and mental health medical sub-specialists. CNC with specialist paediatric skills. Specialist paediatric clinical pharmacist on-site. Allied health professionals with specialist paediatric skills in physiotherapy, social work, dietetics, speech pathology, psychology, occupational therapy and audiology disciplines. Play therapy assistants. Recreational staff and education professionals. |
| 6 |
As for Level 5 plus: Provides comprehensive care across paediatric subspecialties for patients with the highest levels of illness complexity and disease severity. |
Access to full suite of clinical and diagnostic sub-specialty services provided by appropriately trained subspecialty paediatric providers. Subspecialty paediatric consultants available over extended hours. Designated paediatric sub-specialty registrars. School service for long-term inpatients. Has sub-specialist paediatric research and teaching role. |
As for Level 5 plus: Sub-specialist paediatricians. Sub-specialty paediatric registrars and RMOs. CNCs specialising in sub-specialty paediatric care and providing leadership within the service. Allied health professionals on staff with sub-specialist paediatric skills. |
| Level | Service Description | Service Requirements | Workforce Requirements |
|---|---|---|---|
| 1 |
n/a |
n/a |
n/a |
| 2 |
n/a |
n/a |
n/a |
| 3 |
n/a |
n/a |
n/a |
| 4 |
A Level 4 service is primarily an adult intensive care service capable of providing comprehensive high dependency care in collaboration with a paediatric intensive care specialist. Collaborative decision to keep patients made by on-site registered medical specialist with credentials in paediatrics and local registered medical specialist with credentials in intensive care medicine, in consultation with registered medical specialist with credentials in paediatric intensive care medicine. |
Critical care beds occupied by children must have age-appropriate equipment and staff who can meet needs of children. Service capability includes routine monitoring and support of paediatric patients including ECG, oximetry, and short-term invasive measurement of blood pressure with pre-defined acceptable parameters that trigger escalation pathways. Protocols and Guidelines include invasive monitoring and the safe use of vasoactive therapies in paediatric patients. Access to anaesthetic, emergency medicine, or intensive care specialist attendance within 15 minutes for acute medical emergencies. Access to theatre recovery or the Department of Emergency Medicine for short term ventilation and stabilisation whilst awaiting retrieval services. |
Lead clinician with responsibility for clinical governance of service. Access to Intensive Care Specialist. Nurse Unit Manager with post registration qualification in intensive care. RNs with post registration qualification in intensive care / high dependency nursing. Registered nurse with paediatric experience rostered on at all times when children admitted to unit. |
| 5 |
A Level 5 service provides intensive care for children in an ICU, including complex multisystem children’s life support, for:
|
As for Level 5 adult critical care services. Provides invasive ventilation and invasive cardiovascular monitoring in collaboration with paediatric intensive care specialist. Access to paediatric-appropriate equipment capable of managing ventilated infants, children and adolescents. |
Lead clinician who is responsible for clinical governance of service who is Fellow of CICM and registered medical specialist with credentials in intensive care medicine. Paediatrician available 24 hours. Registered medical specialist with credentials in intensive care medicine, rostered and accessible to cover intensive care unit at all times. Support available to unit 24 hours from registered medical specialists with experience in intensive care medicine, anaesthetics and emergency. Nursing staff with skills and qualifications in intensive care available to ensure patient nurse ratio greater than 1:1 for patients requiring complex management. Registered nurse with paediatric experience rostered on at all times when children admitted to unit. Access to allied health providers with specialist paediatric skills in physiotherapy, social work, dietetics, speech pathology. Specialist critical care medicine pharmacist (paediatric) on-site. |
| 6 |
A Level 6 service is a designated paediatric ICU. Provides comprehensive critical care (including complex, multisystem paediatric life support to children for indefinite period, as well as advanced cardiorespiratory support and monitoring, renal replacement therapy and complex neurological monitoring). Elective transfer of patients to lower-level services is supported where services exist to support the patient, and the transfer facilitates better proximity to the patient's family. |
On-site paediatric intensive care unit (PICU) with paediatric-specific intensive care beds and equipment capable of managing ventilated infants, children and adolescents. Provision of medium to long-term mechanical ventilation and full life support for paediatric patients. Provides consultation and leadership for emergency paediatric transport. |
On-site specialist paediatric intensive care specialists on-call 24 hours. Paediatric intensive care registrar. Data collector for reporting to national benchmarking organisations, data audit and to support active research role. Specialist nursing positions including paediatric intensive care nurse educators and intensive care equipment nurse. RNs with post graduate qualifications and/or experience in paediatric intensive/critical care nursing. Specialist critical care medicine pharmacist (paediatric) on-site 7 days per week. |
A paediatric rehabilitation service provides support to children and young people with functional impairments that have arisen from complex health conditions. Children and their families may require support to develop skills for the first time, or to recover from an illness, major trauma or injury. Paediatric rehabilitation care is based on the combined and coordinated use of medical, social, educational and vocational methods for training and retraining of children/young people to achieve their highest possible level of function. The care is goal-directed, time-limited, multidisciplinary, child-focused, and family-centred. Paediatric rehabilitation support can be provided in a variety of ways, across a multitude of care settings including inpatient and same-day admissions and ambulatory care.
| Level | Service Description | Service Requirements | Workforce Requirements |
|---|---|---|---|
| 1 |
n/a |
n/a |
n/a |
| 2 |
A Level 2 service provides ambulatory care via outreach from a higher-level rehabilitation service. Care may be provided in home, community setting or healthcare facilities, generally delivered by allied health and/or nursing led services with oversight from higher level rehabilitation service. |
Service provision includes:
|
Allied Health Assistants and / or rehabilitation assistants. Access to registered medical practitioner. Access to clinical nurse consultant. Access to allied health services including physiotherapy, occupational therapy, speech therapy, dietetics, social work, psychology, orthotics. |
| 3 |
As for Level 2 plus: Provides ambulatory care to clients whose rehabilitation needs are not highly complex. Ambulatory care includes outpatient clinics for ongoing treatment or review; these might be provided by a visiting paediatric rehabilitation specialist from a higher-level rehabilitation service or via telehealth. |
As for Level 2 plus: Multidisciplinary team with access to local nursing and allied health professionals and outreach medical rehabilitation staff from a higher-level rehabilitation service. Established referral pathway between acute, sub-acute, and community rehabilitation services. Allied Health interventions provided by local and/or visiting professionals from a higher-level rehabilitation service or via telehealth. |
As for Level 2 plus: Access to consultant physician with knowledge and skills in rehabilitation from a higher-level rehabilitation service via telehealth. On-site RNs with experience in paediatric rehabilitation nursing. On-site allied health professionals with experience in paediatric rehabilitation. On-site allied health assistants or rehabilitation assistants to support rehabilitation management. |
| 4 |
As for Level 3 plus: Provides rehabilitation assessment and management of a full range of programs for clients of moderate complexity across all settings (inpatient, outpatient, community, home). |
As for Level 3 plus: Designated therapy areas and equipment. Designated local multidisciplinary team with interdisciplinary approach and care coordination. Access to manufacturing of specialist aids and equipment. Access to clinical support services and post-hospital services to facilitate ongoing community management. |
As for Level 3 plus: Access to paediatric rehabilitation physician (visiting or on site). On-site rehabilitation care coordinator. On-site paediatric rehabilitation CNC, psychology, occupational therapy, physiotherapy, dietetics, speech pathology, orthotics and prosthetics. Access to additional specialty services (neuropsychologist). Access to radiology, pathology and pharmacy services. Access to HDU and ICU services. Access to a procedural space, sedation and ultrasound imaging for day procedures including Botulinum toxin injections and Baclofen pump refills. Links with education services, Aboriginal and Torres Strait Islander Health Workers and GPs. |
| 5 |
As for Level 4 plus: Provides care to patients needing specialised rehabilitation care. |
As for Level 4 plus: Designated area on the paediatric and adolescent ward for rehabilitation care (inpatient and day admissions). Dedicated multidisciplinary team led by a rehabilitation physician and comprising specialists with extensive experience in all disciplines (medical, allied health, nursing) who are involved in leadership, liaison and support for other lower-level rehabilitation services. Accredited training site for Australasian Faculty of Rehabilitation Medicine trainees. Additional infrastructure and equipment for patients with complex rehabilitation needs, which include water-based physiotherapy and 2D gait analysis. Designated daily living and therapy areas for activities of daily living and group programs. Established access to tertiary services on referral basis including:
|
As for Level 4 plus: On-site paediatric consultant rehabilitation physician, rehabilitation registrar and accredited training program for registrar in paediatric medicine. Neuropsychologist. Dedicated multidisciplinary team with interdisciplinary approach to care led by a rehabilitation physician. Additional infrastructure and equipment to meet rehabilitation needs of complex patients. 24-hour access to paediatric medicine specialists. Access to surgical disciplines (urology, general surgery, neurosurgery), anaesthetics and ICU. Access to adult rehabilitation specialists for transition of care. Play therapy assistants.
|
| 6 |
As for Level 5 plus: Provides care for clients with the highest complexity, including those with newly acquired traumatic brain injury and spinal cord injury, brachial plexus injury, complex multi-trauma and limb differences (congenital and acquired). |
As for level 5 plus: Provides 24-hour clinical advice and support from a consultant credentialled in paediatric rehabilitation medicine. Diagnostic services relating to the individual specialty available on site. Specialist consultancy services, and specialty outreach services provided. |
As for Level 5 plus: Sub-specialty rehabilitation physicians and programs including brain injury, spinal cord injury and limb difference. An extensive range of allied health professionals available on-site, with demonstrated specialist level knowledge. On-site physiotherapist, occupational therapist and social worker available 7 days a week during business hours. |
Surgery is performed in children for health conditions affecting babies, children and young people. The scope of this Framework describes service requirements and the minimum staffing needs and clinical support services required within each level of surgery for children.
| Level | Service Description | Service Requirements | Workforce Requirements |
|---|---|---|---|
| 1 |
Provides primary / emergency care prior to patient transfer. |
Services delivered in an accredited health care facility. No inpatient services available. Access to more specialised paediatric surgical care at a higher-level service. |
Registered medical practitioner delivering services. Formal consultative links with paediatrician. Formal consultative links with paediatric surgeons from higher level service available 24 hours. Access to allied health services for appropriate follow-up if required including physiotherapy, social work, dietetics, speech pathology, psychology and occupational therapy. |
| 2 |
As for Level 1 plus: Manages low-risk (ASA 1 -2) paediatric patients undergoing SC1 procedures (refer to General Surgery Framework). |
As for Level 1 plus: Surgery performed in health setting with at least one procedure room equipped for paediatric procedures. May have isolation capacity. No paediatric surgical inpatient services available. |
As for Level 1 plus: Registered medical practitioner delivering services. Registered medical practitioner available 24 hours with demonstrated competency in the application of paediatrics anaesthetics if within service scope. RNs with appropriate postgraduate qualifications and/or experience in paediatric nursing. RNs may be supported by ENs in providing care to patients. Access to staff competent in providing paediatric resuscitation. |
| 3 |
As for Level 2 plus: Performs surgery on low anaesthetic risk (ASA 1 -2) paediatric patients undergoing SC2 and SC3 procedures. Capacity to provide overnight admission for paediatric surgical patients. |
As for Level 2 plus: Service provides inpatient and outpatient care by a paediatrician. Operating suite and recovery room provide for the special needs of children and carers. Paediatric surgical, anaesthetic and resuscitation equipment. Access to operating surgeon until patient has recovered from anaesthesia and meets the postanaesthetic care service discharge criteria, as per facility guidelines and Australian and New Zealand College of Anaesthetics (ANZCA). Designated children's surgical beds. Facility to isolate in single room. |
As for Level 2 plus: Operating surgeons credentialed in paediatrics with the approved clinical scope of practice. Anaesthetists credentialed in paediatrics, with the approved clinical scope of practice. Paediatrician on-site during business hours and available 24 hours. Paediatrics registrar available 24 hours. Registered medical practitioner on-site 24 hours. Specialist allied health professionals including physiotherapy, social work, dietetics, speech pathology, psychology and occupational therapy. |
| 4 |
As for Level 3 plus: Capability to perform surgery on: - high anaesthetic risk (ASA ≥4) paediatric patients undergoing SC1 procedures. - medium anaesthetic risk (ASA 3) paediatric patients undergoing SC2 procedures. - low to medium anaesthetic risk (ASA 1 -3) paediatric patients undergoing SC3 procedures. |
As for Level 3 plus: Emergency paediatric surgical procedures are performed where operators are appropriately credentialed with an approved paediatric surgical scope of practice. On-site services able to stabilize emergency paediatric surgical patients prior to transfer to higher level service. |
As for Level 3 plus: Access to staff competent in providing advanced paediatric life support. RNs with appropriate post graduate qualifications and/or extensive experience in paediatric nursing. Clinical pharmacist allocated to inpatient beds on-site. |
| 5 |
As for Level 4 plus: Performs all diagnostic and treatment procedures on ASA categories 1 to 5 in children excluding complex major paediatric surgery. A Level 5 services has a specialised paediatric inpatient unit with nominated Lead of Paediatric Surgery. Provide paediatric support to other units. |
As for Level 4 plus: Designated paediatric surgical ward area. On-site specialist neonatal and paediatric ICU services. |
As for Level 4 plus: Paediatric surgeons available 24 hours. Specialist anaesthetists (paediatric) available 24 hours. Paediatric surgical registrar during business hours. After-hours surgical registrar reports to paediatric surgical consultant. RNs with appropriate post graduate qualifications and/or extensive experience in paediatric surgical nursing. Paediatric clinical pharmacist on site. Allied health professionals with specialist paediatric skills in physiotherapy, social work, occupational therapy, speech pathology, OPST and play therapy assistants. |
| 6 |
As for Level 5 plus: Has sub-specialty units in most areas of paediatric surgery including complex major paediatric surgery (e.g., paediatric neurosurgery, paediatric cardiac surgery, transplantation disciplines). |
As for Level 5 plus: Designated sub-specialty paediatric surgical wards with parent amenities. |
As for Level 5 plus: Sub-specialty paediatric surgeons. Paediatric surgical sub-specialty registrars. Paediatric sub-specialty nurses across disciplines. Sub-specialist allied health services. General paediatricians on-site 24 hours. Sub-specialty paediatric surgeons on-call 24 hours, seven days a week. Designated paediatric surgical sub-specialty registrars in sub-specialty units. |
