Keeping kids closer to home : Experiences of an expanded scope and Allied Health assistant delegation model for paediatric burn rehabilitation

Ms Debra Phillips1, Ms Lauren Matheson1, Dr Tilley Pain1,2, Dr  Gail Kingston1,2

1The Townsville Hospital, Townsville, Australia, 2James Cook University, Townsville, Australia

Background: Post burn injury, rural and remote children are geographically disadvantaged compared to metropolitan children in Australia. Specialist services for burn management are in tertiary hospitals located regional or metropolitan centres; and rural and remote children are more likely to have complications following a burn injury. Children with deeper burns require complicated rehabilitation, including allied health intervention, to achieve optimal outcomes. The Townsville Hospital established the Occupational Therapy Led Paediatric Burns Telehealth Clinic (OTPBTC) to reduce rural disadvantage. In this expanded scope model, the occupational therapist is responsible for monitoring children undergoing active burn rehabilitation rather than a Paediatric Surgeon. Clinical indicators are used to guide re-engagement of the surgeon when review is indicated and Allied Health Assistants are delegated clinical and non-clinical tasks to increase efficiencies.

Aim: The aim of this research is to explore the experiences had by families and clinicians utilizing the OTPBTC.

Method: This qualitative study used an interpretive phenomenological approach to explore family”s and clinician’s experiences with OTPBTC. Families and clinicians who have participated in telehealth reviews were purposefully selected and invited for interview. (HREC/17/QTHS/221)

Results: Themes from the interviews show families value accessing health care services close to home. Staying close to home reduces time off work and school with minimal disruption to daily life. Families and clinicians highlighted their confidence in the occupational therapist’s ability to manage the child’s rehabilitation via telehealth and act as the point of contact for their ongoing care. Rural clinicians benefitted from specialist advice and gained knowledge for their skill development.

Conclusions: This research demonstrates the value families place on receiving care close to home and the role telehealth and expanded scope positions plays in supporting this. Success of this local study demonstrates this model of care can be implemented in other health services across Australia.


Dr Gail Kingston Gail is the Assistant Director of Occupational Therapy at The Townsville Hospital. Since graduating from the University of Sydney in 1992, Gail has worked primarily within acute tertiary hospital settings in NSW and QLD.   She completed a PhD in 2014 titled Occupational therapy and/or physiotherapy services following a traumatic hand injury for people who live in rural and remote locations.  Gail’s ongoing research interests include occupational therapy models of care in acute hospitals and service delivery models for the management of hand and burn injuries in rural and remote residents.


Debra Phillips Deb Phillips is a Senior Paediatric Occupational Therapist at The Townsville Hospital.  She has worked with children with burn injuries for over fifteen years and is currently undertaking a post graduate diploma in burns rehabilitation. Debra developed the Occupational Therapy Led Paediatric Burns Telehealth Clinic in 2017 in conjunction with the Paediatric Surgery Department at The Townsville Hospital. This ground-breaking initiative received the Queensland Health Service Delivery Award in 2018.

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