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Paediatric Levels of Care

Paediatric Levels of Care (PLC)

Background

In Ontario, there are approximately 95 hospitals that care for paediatric inpatients. Of these hospitals, approximately 45 have dedicated paediatric units, with 5 academic centres that provide care to paediatric inpatients with high acuity, high medical and procedural complexity, and have a broad range of paediatric sub-subspecialists.

As infants, children, and youths are not just ‘small adults’ and require care by those with specific paediatric skills and expertise, there is variation in admission criteria and specific services offered by hospitals across the province. While organizations have been able identify the specific services available at hospitals throughout the province for this population, Ontario has not had a universally accepted set of definitions and criteria for levels that define paediatric inpatient care with related standardized scope of service descriptions.

In 2011, the Provincial Council for Maternal and Child Health (PCMCH) partnered with Local Health Integration Networks (LHINs), now known as Ontario Health Interim and Transitional Regions, to implement standardized definitions of maternal and newborn levels of care across hospitals in Ontario. Recognizing that these levels aim to provide equitable access to care at the appropriate level for all pregnant women and newborns in Ontario, there was acknowledgement that implementing standardized definitions for the paediatric inpatient population would do the same. Together, these aim to enable a seamless system of care across the maternal-newborn-paediatric continuum.

A work group was assembled and recommended standardized level of care definitions for paediatric inpatients. These definitions have been endorsed by PCMCH, and throughout their development, have also been vetted by external stakeholders, including clinical and administrative representatives from hospitals, senior clinical and administrative leadership at Paediatric Academic Health Sciences Centres (PAHSCs), and other stakeholders from across Ontario that have direct impact on the paediatric inpatient population.

As a province, we are now ready to implement these standardized definitions for paediatric levels of care, which are intended to:

  • Provide a clear, consistent, and transparent understanding of services provided by any given hospital site;
  • Enable healthcare professionals to know where to call for advice and consultation;
  • Support the flow of patients to both higher and lower levels of care, including repatriation;
  • Foster shared-care management of patients when appropriate;
  • Facilitate dialogue that will help to identify gaps and opportunities for capacity building, quality initiatives, etc. at the organizational, regional and provincial level; and
  • Enable a seamless system of care across the maternal-newborn-paediatric continuum.

PLC Organizational Self-Assessment Survey

In October 2018, all hospitals in Ontario were asked to complete the Paediatric Levels of Care Organizational Self-Assessment Survey in order to understand the paediatric inpatient services hospitals are able to provide with current resources. This process was not about increasing or decreasing capacity and instead is about standardization and formally acknowledging services hospitals are able to provide with current resources. There is no additional funding for sites attached to this process.

Next Steps

As Paediatric Levels of Care is a new initiative, some hospitals may not have met all mandatory criteria.

All hospitals are encouraged to meet their mandatory criteria.  Hospitals will be reassessed every 4-5 years, with the next assessment planned for 2022.

In order to optimize access and expert care in geographically vast areas with limited available expertise and resources, PCMCH recommends a regional model approach where Paediatric Academic Health Sciences Centres and Community Hospitals work together to build effective and collaborative partnerships for your region. More communications about the regional model approach will be provided in the near future.

The Ministry of Health supports this initiative. If you have any questions, please contact ploc@pcmch.on.ca

Resources

Acuity, Medical Complexity & Procedural Complexity