
Investing in pediatric outpatient care: Expanding access and improving outcomes
At Hamilton Health Sciences’ McMaster Children’s Hospital (MCH), ambulatory clinics serve as the frontline access points for thousands of young patients and their families each year. These clinics provide specialty medical care on an outpatient basis for patients who don’t need to stay in the hospital. The clinics play a vital role in addressing a wide range of pediatric health care needs, from surgery follow-ups to specialized treatment for complex, chronic conditions.
Recently, MCH’s ambulatory services were facing challenges with timely access and long wait times with increased patient volumes by up to 50 per cent and ongoing impacts from the COVID-19 pandemic. Some areas of care saw waiting lists exceeding two years.
In July 2023, MCH received a provincial investment of more than $48M, the largest investment in the hospital’s history, to help support the transformation of pediatric care in our region.
That investment included funding for MCH to significantly enhance the capacity and capabilities of ambulatory services, address wait times and improve access to quality care for the children and families we serve.
“With the right resources and support, it’s evident that we can truly transform the landscape of pediatric health care in our community.”

Karen Margallo, Director of Child and Youth Ambulatory services
“We knew that in order to truly move the needle on wait times and service gaps, we needed to make strategic investments to grow our ambulatory capacity,” said Karen Margallo, Director of Child and Youth Ambulatory services at MCH. “This investment has given us the resources to grow our teams, expand our physical spaces, and ultimately see 4000 more patients in a more efficient and effective way.”
In the first year alone, the pediatric health recovery funding enabled a 14 per cent increase in overall visit volumes across all MCH ambulatory clinics. This was achieved through a multi-pronged approach that included hiring more than 81 staff and implementing innovative solutions to care, such as piloting extended clinic hours and providing virtual services, and renovations to accommodate the growth in staff and services.
Hiring efforts focused on advanced practice providers. These are health care providers such as nurse practitioners and physician assistants, who are not doctors but have special training and are licensed to diagnose, treat and manage many common medical conditions. For example, advanced practice providers can perform physical exams, order laboratory tests and imaging tests, review test results, prescribe medications, make referrals and much more. This creates capacity to see more patients waiting for care, take on new referrals, and alleviate some of the pressure on physicians and other clinicians. In addition, MCH was able to add allied health and nursing staff to better streamline follow-up clinics to optimize clinical service and operations.
“While investment in ambulatory care is one essential piece of care we provide, it’s interconnected and part of a bigger picture – all working together to help our community heal and thrive.”
This year, MCH predicts 16,000 more visits to ambulatory clinics or approximately 120,394 projected total clinic visits. This is an increase of 16 per cent over last year and 33 per cent over two years ago. While the impact of the funding has been profound and elevated every area of the hospital, the work is far from done. Growing demand for ambulatory services mean that wait times remain a challenge in many specialty areas.
The initiative has laid important groundwork, and MCH remains committed to continued advocacy to ensure all children in the region can access the high-quality, timely care they deserve.
“This is just the beginning. With the right resources and support, it’s evident that we can truly transform the landscape of pediatric health care in our community,” added Margallo. “While investment in ambulatory care is one essential piece of care we provide, it’s interconnected and part of a bigger picture – all working together to help our community heal and thrive.”
Funding impact in action: Staff transforming care for children
At MCH, our expert staff are making a difference in enhancing the lives of children, youth and families. The following testimonials feature MCH staff in new or expanded roles thanks to recent funding, underscoring the profound effect of investments and the compassionate care we strive to provide.
Alannah Courte, social worker, Children’s Exercise and Nutrition
“As a newly funded social worker in the Children’s Exercise and Nutrition (CENC) program, I conduct a biopsychosocial assessment with each family participating in the Growing Healthy Program. This assessment helps identify each family’s strengths, challenges and supports that have an impact on their engagement in the program. I provide ongoing support throughout their time in the program by offering counseling, connecting families to resources, advocating for their needs, and addressing any concerns or barriers they face.
“By addressing social factors such as food insecurity, low self-esteem, financial stress, and mental health challenges, we ensure that each family receives comprehensive care. This approach not only bridges existing gaps but also highlights the critical importance of social work within CENC. By fostering a supportive environment, social work empowers families to overcome obstacles, promotes lasting health behaviour changes, and ultimately contributes to the overall well-being of children and their families.”
Evelyn Brydges, nurse practitioner, Children’s Exercise and Nutrition Center – Growing Healthy Program
“My role as a nurse practitioner is to conduct an initial assessment with the child and family to begin to understand their health goals for the time in the program, to screen for cardio-metabolic health conditions, and to determine the need for genetic testing. The role also includes health promotion around sleep, screen time, and prevention of chronic health conditions. I work closely with our team members to support nutrition, physical activity and mental health.
“Throughout the duration of the two-year program, medical care for our patients is shared between the physicians and the nurse practitioners on the team. Provincial funding has helped to create an additional nurse practitioner role on this team to increase timely access to specialized care for our patients.”
Krista Binnington, clinical manager, Pediatric Ambulatory Clinics
“We’re grateful to receive these resources as it has allowed us to expand the pediatric urology service’s capacity to provide care to a larger number of patients, not only resulting in patients and families being seen sooner, but also having one more health care provider allows more time to be spent with patients, resulting in improved quality of care.”
Dr. Abbi Reid Graves, Ph.D., C.Psych, neuropsychologist & clinical psychologist, Pediatric Neurology & Pediatric Neurosurgery
“I conduct neurocognitive assessments with children with a wide variety of neurological conditions (e.g., epilepsy, genetic disorders, pediatric MS, stroke, hydrocephalus, arteriovenous malformations, craniosynostosis, etc.), or who are undergoing, or have undergone, neurosurgical interventions. These assessments are used for pre-surgical planning, monitoring of medical interventions, and for children and families to access resources in the community and school environments.
“The additional funding that has been provided to our programs has allowed me to increase the number of children who can receive these very important assessments. Our waiting list is often one to two years. When children are struggling in school, this can mean up to two years of their education is affected because they cannot access the appropriate resources and support. With increased funding, children can begin receiving the necessary interventions, resources, and supports sooner.”
Dr. Michelle Batthish, pediatric rheumatologist and division head
“Thanks to the pediatric recovery funding MCH received, our team was able to hire Julie Herrington as our advanced practice physiotherapist full time, up from only one day per week. Julie has been able to alleviate our wait times as she is able to see new patients and follow up. I’ve received many notes of gratitude from her patients that highlight just how much her role has improved care for MCH patients and families.”
Sami Hill, child life specialist, Fracture Clinic
“I am grateful to receive these resources as it has allowed for more patients and families to be offered child life support throughout McMaster Children’s Hospital. This has improved our team’s ability to prioritize patient’s emotional wellbeing in addition to their physical health. I’ve also witnessed many patients who had previously required sedation for procedures cope successfully with only child life support. This would not be possible without the additional resources provided.
“Now, child life specialists can spend more time teaching coping skills to patients, and also find ways to adapt our clinic environments to better support patient’s coping.”
Dr. Linda Pedder, head of service, Respirology
“With the approval of a new cystic fibrosis drug several years ago, our enrollment of patients has altered and increased the workload of the entire cystic fibrosis team. There are quarterly mandated assessments for all enrolled patients, including testing to ensure they can remain on the drug. The recent funding supported the addition of a second registered nurse and nurse practitioner, enabling our team to provide timely access to the drug, monitoring and overall clinic flow.
“The new respiratory therapist has allowed timely access to patients requiring cough assistance, while two new respirology nurse practitioners have improved triage, data collection and increased the number of follow-up patients to be seen, allowing the physicians to see more new consultations and patients overall.”
Note of gratitude from an MCH parent
“The difference since meeting with you (Jules) is night and day. He is feeling much less burdened by his anxiety and has come home a different kid after meeting with you. He has not had a panic attack since his last session with you in July! His fear of death has had such a solid grip on him that he’d grown fearful of swimming and had begged me to let him quit his summer lessons. He’s swimming laps in the pool as I write this – something we truly didn’t think was possible. He has come so far, and we could not be more grateful for your support throughout these last several months. He has become an entirely different kid. Thank you for assisting him at each step of the way and providing extra support when his anxiety was impacting him every single day. It is such a joy to see him living his life to the fullest. Thank you so very much for being so incredibly skilled at what you do.”
Jules Verdugo, child life specialist, GI, Nephrology and Cystic Fibrosis
“I am so extremely grateful to have been able to support this patient from before his diagnosis, to hospital stay, treatment and remission. The increased ability to have a dedicated child life specialist in the GI clinic supports patients’ resilience by tackling medical anxiety and psychosocial concerns arising from medical experiences. This has meant an improved patient experience, more efficient use of hospital resources, and overall, more well-rounded person- and family-centered care.”