Telethon Trust Research Fellowships: How Australian-first Hospital within the Home initiative is driving change | USAEMALL.com

Little Leo Piliae was not quite two months old when his parents realised he was struggling to breathe and rushed him to hospital.

A cascade of infections meant Leo had to spend four nights in Perth Children’s Hospital, while his parents juggled the need to also care for their other three children at home.

The family leapt at an offer to take part in a pilot program for a new service giving WA kids nearing the end of a hospital stay the option to complete their recovery at home.

“He had RSV and rhinovirus at the same time, which he was OK with, but then he developed bronchiolitis, and that’s what gave him breathing difficulties,” says Leo’s mum, Caitlin.

“My husband had to take time off work for the whole time and just be home with (the other children) while I was at the hospital.”

Caitlin says the Hospital in the Home initiative, which combines wearable monitors with daily home visits from paediatric nurses, had been the perfect fit for her family.

“I was dying to get home to be with the other kids — so it was just such a good option for us.”

It’s a program she would not hesitate to recommend to other parents. “Definitely — it just gives a lot more peace of mind being home and not having to worry about them so much.”

Led by PCH doctor Simon Moore, Hospital in the Home — believed to be the first of its kind offered by a paediatric health care service in Australia — is one of the many research programs made possible by funding for Telethon Trust Research Fellowships.

This year marks the 40th anniversary of the fellowship program that has been a driving force for paediatric research.

Dr Moore, one of the latest in a long line of luminaries to receive a fellowship, says it’s enabled him to dedicate time to the research project.

“We had the concept within our team that we could set up this Hospital in the Home remote monitoring service as a pilot to see if it would work as a kind of new way to provide care closer to home for families,” he says.

“But equally, to take the pressure off the hospital, which in winter time is always bursting at the seams.”

As part of a 12-month feasibility study, he has been investigating whether the program is a cost-effective and acceptable model of care for families and clinicians.

The program is offered only to children deemed medically stable who are close to being discharged.

Children who use the service are equipped with wearable monitoring devices that track heart rate, temperature and oxygen saturation before they leave hospital, with their families given guidance on how to use them.

Patients are physically assessed once a day by nurses, as well as taking part in at least one telehealth review each day.

The study, which aims to recruit around 1000 families, has already been credited with reducing disruptions to schooling and work, as well as freeing up hospital beds.

“We’ve had quite a big impact on the hospital,” says Dr Moore. “We’ve had 630 patients come on to the service since we started.”

This in turn has freed up more than 1000 hospital beds.

In the four decades since it first began offering seed funding for early-career researchers, Telethon has empowered 96 fellows to turn concepts into best-practice, world-changing paediatric care.

Another one of those early beneficiaries was 2001 fellow Meredith Borland — now a paediatric emergency physician and director of emergency medicine at PCH.

Professor Borland’s early work on intranasal fentanyl for children in severe pain from acute fractures helped to change paediatric pain-relief practice in emergency departments across the world.

Previously, the only way to give kids a strong painkiller was via an IV drip or an injection — both of which took more than 30 minutes to take effect.

“What we determined was that with fentanyl — which is a strong analgesic like morphine — you could give it to a patient by spraying it, atomising it, up the nose, and you get the benefit of the analgesic much quicker, within 15 minutes,” Professor Borland says. “Seeing a problem and seeing a potential solution is a real opportunity, particularly when you’re young and keen, to actually look at using Telethon to assist you with exploring that in more detail.”

In the 40 years since Tim Jones became WA’s first Telethon fellowship recipient, he has been recognised internationally for clinical investigation in childhood diabetes.

Professor Jones, now the co-director of medicine at PCH, still has the original typed letter he received in 1986 from popular TV personality of the day Stuart Wagstaff, congratulating him on being named the inaugural fellow.

“Before the Telethon fellowships, if you wanted to train in a speciality, there was no funding,” he says.

“It was my first year of doing paediatric endocrinology diabetes, and I was able to mix that with some research projects at the same time. It was fantastic.”

In the 1980s it was common for diabetic children to have convulsions if their blood sugar levels fell too low.

“We learnt a lot about what causes it, how to prevent it — so now we don’t see it,” Professor Jones says.

He says Telethon funding has enabled a culture of research to grow at PCH, raising the standard of care.

“The only way you can improve things is through research,” he says. “I’m incredibly fortunate — I’ve spent mornings seeing patients and also doing research at the same time. It’s a privilege.

“The families like it too — they like to know they’re going somewhere that’s doing the latest, because they feel they’re getting the best.”