More than 70 Niagara children under the age of five received timely, coordinated tuberculosis (TB) screening and follow-up this summer after an exposure at a local daycare.
The children needed timely screening, chest X-rays, medical assessments and, in some cases, specialized follow-up. Niagara Health, Niagara Region Public Health and McMaster Children's Hospital quickly mobilized to create a coordinated outpatient care plan. Without that collaboration, many families would have faced travel to Hamilton for care.
"Rather than asking families to navigate multiple services independently or travel out of region for assessment, we created a coordinated outpatient pathway that was clinically appropriate, easier for families to access and more efficient for the healthcare system," Dr. Katelyn MacKenzie, Niagara Health’s Chief of Pediatrics, who helped lead the local response.
Young children require particular attention following exposure to infectious TB because they are at greater risk of developing severe disease, says Dr. Angela Ma, Associate Medical Officer of Health at Niagara Region Public Health.
“The speed and openness of the collaboration stood out,” says Ma. “Everyone came together quickly to assess the situation, share expertise and determine the best path forward for families.”
Rather than asking one organization to absorb an unexpected surge in demand, the partners looked at what each could contribute and built the response around those strengths.
“There was no way McMaster hospital alone could have taken on this number of children in an optimal way,” says Laura Bainbridge, a registered nurse with McMaster Children’s Hospital’s Infectious Diseases Clinic. McMaster ultimately followed 25 of the more than 70 children.
What began as discussions between Public Health and McMaster quickly evolved into a highly coordinated partnership that included Niagara Health’s Pediatric, Diagnostic Imaging and Children’s Health teams.
The organizations met weekly to review cases, coordinate care and respond to emerging needs, helping families navigate a challenging situation. Niagara Health's Diagnostic Imaging team provided timely access to chest X-rays, Public Health coordinated and interpreted TB skin testing and the Niagara Health Pediatric Clinic assessed about 40 children considered lower risk. Children requiring specialized infectious disease care were referred to McMaster. Keeping care close to home and reducing stress for families remained a key focus throughout the response.
“We knew this news would be understandably worrying for parents, so it was important to not only provide timely assessments but also reassure families that their children were being cared for by a coordinated team of pediatric experts,” says Natalie Doucet, Director of Women and Babies & Children’s Health program.
The coordinated outpatient pathway ensured children could be assessed in the setting most appropriate to their needs, while emergency departments remailed available for patients requiring immediate care. Dr. Sarah Khan of McMaster Pediatric Infectious Diseases notes that emergency departments would not have been the most appropriate setting for this type of assessment, particularly given ongoing pressures on emergency services.
The response also needed to accommodate the realities of busy family life. Travel plans, recent vaccinations and other clinical considerations affected how and when some children could be assessed. Rather than leaving families to navigate those complexities on their own, the teams worked through them together.
McMaster specialists provided direct support to Niagara Health pediatricians as they assessed children locally. When chest X-rays required a closer look, McMaster’s pediatric sub-specialty radiologists were able to assess the images remotely, helping some families avoid extra appointments or travel.
For families, the difference was significant. Rather than navigating multiple organizations and appointments independently, they had access to a coordinated plan that connected screening, imaging, pediatric assessment and specialist expertise, much of it available close to home.
The approach highlighted the value of established relationships between organizations. Because teams across all three organizations already work closely together, they were able to act quickly.
For Bainbridge, who has worked at McMaster Children’s Hospital for 23 years, the experience was particularly memorable.
“I have never experienced such a positive large group effort across multiple expertise and regions,” she says. “Everyone had the same vision and came together with such positivity. It really has given me such hope and a positive outlook at a time when things are so challenging for so many.”
