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Paediatric Medicine
Paediatric Medicine

The Added Value

What services can the complex care team add to my child’s care?

The Complex Care team provides different services based on your child and family’s individual needs. These services may include:

Care coordination: The complex care team works toward coordinating care between multiple providers. This can help improve communication and create joint plans of care.

Continuity: There are many health-care providers involved in your child’s care both in hospital and at home. The complex care team becomes familiar with all of your child’s health care concerns over time.  

Direct Access: The complex care team provides direct access for medical information and support. You will have access to a nurse practitioner who you can communicate with between visits or when you have questions or concerns.  
Goal Setting
: The complex care team can help your family develop short and long- term goals for your child’s care.

Decision-making: The complex care team can help your family make informed decisions about plans of treatment or care for your child both in the short and long term.

Coordination of Appointments: The complex care team can help with organizing tests, procedures and appointments when possible. You will have access to our Information Coordinator who can assist with appointment scheduling.

Written Care Plan: A SickKids document can be created to help summarize your child’s medical conditions and health needs to promote communication with other health-care providers involved in your child’s care outside of the hospital.

Multi-disciplinary Care: You may receive care from any of the complex care health-care professionals including a paediatrician, nurse practitioner, clinical nurse specialist, social worker, clinical dietitian, pharmacists, information coordinator, psychiatrist, occupational therapists, and physiotherapists.

What else can the complex care team add to my child’s care?

In addition to the services our team can offer you and your child, there is additional value that the complex care team can add to your child’s care.The complex care team focuses on an individualized, family-centered approach to care. By getting to know your child and family, the complex care team can work with you as your child’s voice in the larger health-care system.The complex care team offers familiar faces in an ever-changing environment. Along with those faces comes the knowledge that the members of the team know your child and family and will partner with you to reach your goals.

Inpatient

Part of complex care involves an inpatient team. If your child has frequent or prolonged admissions to SickKids, the inpatient complex care team may be part of your care team while your child is in hospital. The inpatient team consists of a clinical nurse specialist (or CNS) and a complex care paediatrician. The role of the inpatient complex care team is to assist in coordinating the aspects of your child’s care in hospital, and providing continuity in an environment of frequent change.

Outpatient

The complex care team provides preventative health care delivery for children with medical complexity both at SickKids and in the community. The goal of the outpatient care team is to provide multi-disciplinary and collaborative care to enhance care delivery, coordination and medical care for patients with medical complexity. The health-care team within the clinic consists of a paediatrician and a nurse practitioner. In addition, other health-care providers are invited to join based on individual patient need. These professionals include Community Care Access Centre (CCAC) case coordinator, social work, clinical dietitian, occupational therapist, physiotherapist and/or speech therapist.  

Satellite Clinics

The complex care program has satellite clinics located within various community hospitals in Ontario. These clinics provide complex care services in a location closer to home. Enrollment within these clinics is determined based on the patient’s geographical location of residence (LHIN). These clinics involve the local health care team as well as a nurse practitioner from SickKids whose role is to consult and to provide advanced care coordination between SickKids and the community.

The satellite clinics aim to provide accessible, comprehensive and continuous care by integrating care between the patient’s community and SickKids' health-care providers. The benefits from satellite complex care clinics include:

  •  Provision of complex health-care services closer to home.
  •  Improved overall access to care.
  •  Improved access to community based services.
  •  Improved communication and collaboration of care between community and SickKids providers.
  •  Improved coordination of care at SickKids.
  •  Decreased out of pocket expenses to families for travel to SickKids and taking time off work.

There are currently six satellite complex care clinics:

If you would like to have your child referred to our program, please have a medical professional complete a referral form:

Complex care referral form