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WMNTS Activity. April 2012-March 2013. Who We Are. Operational Policy. Provide 24/7 retrieval service Provide daily back transfer service 9-5 Monday-Friday cot locator service Retrieve from neonatal units or neonates from BCH/Alder Hey. Transfer numbers Refusals Data collection

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WMNTS Activity

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WMNTS Activity

April 2012-March 2013


Who We Are


Operational Policy

  • Provide 24/7 retrieval service

  • Provide daily back transfer service

  • 9-5 Monday-Friday cot locator service

  • Retrieve from neonatal units or neonates from BCH/Alder Hey


  • Transfer numbers

  • Refusals

  • Data collection

  • Types of Transfers

  • Time critical transfers

  • Staffing

  • Clinical Incidents

  • Budget

  • Changes


  • Transfer numbers

  • Refusals

  • Data collection

  • Types of Transfers

  • Time critical transfers

  • Staffing

  • Clinical Incidents

  • Budget

  • Changes


Transfers 2009-2013


Activity 2012-13


Other includes repatriation from LWH, Alder Hey, Bristol(s), Arrowe Park)


  • Transfer numbers

  • Refusals

  • Data collection

  • Types of Transfers

  • Time critical transfers

  • Staffing

  • Clinical Incidents

  • Budget

  • Changes


  • Transfers performed(1180)/ requested (1547)= (76%)

  • But only 118 of those not performed were for WMNTS reasons

    Therefore (1547-118)/1547 could have been performed by WMNTS = 92% (both networks)


  • Transfer numbers

  • Refusals

  • Data collection - old

  • Types of Transfers

  • Time critical transfers

  • Staffing

  • Budget

  • Clinical Incidents

  • Changes


Data Collection April 12-Dec 12


  • Transfer numbers

  • Refusals

  • Data collection

  • Types of Transfers - old

  • Time critical transfers

  • Staffing

  • Clinical Incidents

  • Budget

  • Changes


Medical Transfers 12-13


Cardiac Transfers


Surgical 12-13


Surgical Transfers


Specialist 12-13


Back Transfers 12-13


Cot Management


  • Transfer numbers

  • Refusals

  • Data collection - new

  • Types of Transfers

  • Time critical transfers

  • Staffing

  • Clinical Incidents

  • Budget

  • Changes


Since Jan 13

Replaced by a 4-level categorisation

  • EVERY inter-hospital neonatal transfer categorised against these categories.


BAPM category of care

Pick ONE

Notes: Transitional care / normal care not included as basic monitoring used for all babies in transfer


Primary clinical reason for transfer

Pick ONE

Categorise on the intended treatment the infant will receive on completion of transfer.


Primary operational reason for transfer

Pick ONE

Notes:

Uplift: Transfer for care that the referring centre does not normally offer


Time

Pick ONE

Use intention to treat throughout. Within what timescale did you set-out to arrange this transfer?


  • Transfer numbers

  • Refusals

  • Data collection

  • Types of Transfers - new

  • Time critical transfers

  • Staffing

  • Clinical Incidents

  • Budget

  • Changes


Example – March 2013


  • Transfer numbers

  • Refusals

  • Data collection

  • Types of Transfers

  • Time critical transfers

  • Staffing

  • Clinical Incidents

  • Budget

  • Changes


Gastroschisis

Ventilated infant with Tracheo-oesophageal fistula +/- atresia

Intestinal perforation

Suspected duct-dependent cardiac lesion not responding to prostin

Unstable respiratory or cardiovascular failure not responding to appropriate management:

Despite giving appropriate ventilation via endotracheal tube the infant’s respiratory status remains unstable or severely compromised:

persistent unstable pneumothorax despite chest drain requiring FiO2 100%

arterial oxygen < 5kPa on 2 consecutive blood gas measurements

pH <7.1 and pCO2 >9kPa

persistent mean blood pressure below corrected gestational age, measured on arterial line; if measured with cuff only, there should also be acidosis (pH <7.1)

Clinical criteria for categorising as Time Critical


Time Critical Transfers


Types of Time Critical Transfers

No CHD not responding to prostaglandin infusion (4) ; No (5) recorded


Meeting standards for time critical transfers

  • WMNTS dispatch times for all TCT=31 mins (0-95 mins)(n=28)

  • (20 mins if on-call /bed availability etc excluded (n=21))

  • WMNTS dispatch times for TCT

    • LNU –18 mins (n=3)

    • SCU - 0

  • Use appropriate neighbouring team if standard cannot be met – KIDS, CenTre (1 performed by KIDS; WMNTS performed 1 for CenTre)


Dispatch <1 hour

1 transfer performed for CenTre; 1 transfer performed by KIDS as WMNTS oncall


Geographical Area Covered


Travelling times from Base Hospital


  • Transfer numbers

  • Refusals

  • Data collection

  • Types of Transfers

  • Time critical transfers

  • Staffing

  • Clinical Incidents

  • Budget

  • Changes


Staffing


  • Transfer numbers

  • Refusals

  • Data collection

  • Types of Transfers

  • Time critical transfers

  • Staffing

  • Clinical Incidents

  • Budget

  • Changes


Clinical Incidents


Comparison of Incidents


Types of Incidents


  • Transfer numbers

  • Refusals

  • Data collection

  • Types of Transfers

  • Time critical transfers

  • Staffing

  • Clinical Incidents

  • Budget

  • Changes


Budget


  • Transfer numbers

  • Refusals

  • Data collection

  • Types of Transfers

  • Time critical transfers

  • Staffing

  • Clinical Incident

  • Budget

  • Changes


Developments over the last 6 months


Changes to Working Practice

  • Team now on site at night tues- thurs – allows overnight planned back transfers

  • Rotational post between BWH & WMNTS commencing

  • Succession planning with 2 student ANNPs


Ambulance Driver Training


New Ambulances


Parents Travelling with Babies


Tecotherm Mattress & Trolley


WMNTS Objectives 2013-14


Terms of Reference


  • TERMS OF REFERENCE OF THE WEST MIDLANDS TRANSFER USER GROUP (wmTUG)

    The group is responsible for:

    • Monitoring the effectiveness of the West Midlands Neonatal Transfer Service (WMNTS)

    • Identifying transfer issues and future transport requirements within the Networks

    • Identifying investment required to achieve a robust transfer service for the Networks

    • Making recommendations to the Network Boards to improve transport collectively within the Operational Delivery Networks (ODN) in line with the recommendations in the Review of Neonatal Intensive Care Services and the Toolkit for High Quality Neonatal Services

    • Implement, review and further develop transfer guideline, protocols and procedures for use across the Networks

    • Make recommendations for standardising transport education and training across the Networks

    • Continue to contribute to regional and national discussions relating to developments in neonatal transfers

  • ACCOUNTABILITY, RESPONSIBILITIES AND PERFORMANCE MANAGEMENT

    • The members of the Transfer Group will be accountable to the ODN Boards and are responsible for providing progress reports to the boards.

    • Chair to be rotated between the Transport Consultant Leads, in their absence Transport Nurse Consultant to chair

    • The Chair of the group will be accountable to the 2 ODN Boards for the effective performance of the group.


  • MEMBERSHIP

    • WMNTS team members

    • One neonatal medical/nurse representative from each provider Trust and deputy

    • One obstetric/midwifery representative from each provider Trust and deputy

    • A representative from Patient First Ambulance Service

    • Network Managers

    • Network Practice Educators

    • WMNTS Administrator (minute taker)

    • Parent user

    • SCN/ senate members

    • Member of NHS commissioning body


  • MEETINGS AND PROCEDURES

    • The group shall hold meetings as necessary, however unless agreed otherwise, meetings should be held twice a year. Venue will be rotated between the two networks where possible.

    • All meetings shall be arranged and serviced by the WMNTS Administrator hosting the meeting

    • Group members will receive written notice of the meeting in the form of a copy of the agenda and relevant papers, which will be circulated at least 5 working days in advance of the meeting.

    • Special meetings may be called as necessary by either the Chair or at least 2 members of the group from each of the network if it is determined that there are urgent matters to be considered. In such circumstances the written notice of the meeting may not be less than the prescribed 3 working days.

    • Meetings of the Transfer User Group will be deemed quorate if there is 4 representatives from each of the Networks – if response suggests that the meeting will not be quorate the lead transport consultant/ nurse consultant may decide to cancel the meeting at short notice unless there are any issues requiring urgent action

    • Every question to be decided at a meeting shall be determined by the majority of votes of members present. Where there is equal division of votes, the chair shall have a casting vote.

    • No matter which the group has agreed may be rescinded or varied at a subsequent meeting unless that rescission or variation is a specific item of business on the agenda for that meeting.

    • Deputies will be encouraged.

    • Regular reports and updates on progress made to the ODN Board


Hosted by:

National Transport Group Conference 2013

Friday 29th November 2013

Burlington Hotel Birmingham B2 4JQ

Programme of Events

  • Welcome

  • Chairman’s report

  • The Challenges of Neonates for a Paediatric Intensive Care Retrieval Service

  • The Australian Transport Service

  • The Parent’s Perspective

  • Guest Speaker

  • Poster Presentations

  • Close

Abstracts

Authors are invited to submit audit or research abstracts to [email protected] (see separate application form)

Abstracts can be original research, development of a new guideline or audit. All must have relevance to neonatal transport medicine.

Abstracts should state briefly and clearly the purpose, methods, results and conclusions of the work with a maximum word count of 350 words.

Deadline for submission is 30th September 2013

Accepted admissions to be notified by 18th October 2013

Prices

Delegate rate £100 - day conference fee and dinner

Special team rate £500 - day conference fee and dinner for 5 people + 1 person free

Further information relating to accommodation, location and local amenities on separate flyer


Cooling Activity

April 2012 ~ March 2013


Requests from


Transfers requests Per network

2

17

32


Transfer To


Transfers performed To each network

  • 50% of babies were admitted to SSBCNN for therapeutic hypothermia

  • 50% of babies were admitted to SWMNN for therapeutic hypothermia

  • 14

17


Transfers performed

Referral age


Transfers performed

Response time (Call → Arrival on Ref. NNU)


Transfers performed

Age at Cooling centre


Transfers performed

Age 33-34°C Achieved


Transfers performed

Methods of cooling


Transfers performed

Babies not cooled


Transfers performed

Ventilatory support


Transfers performed

Paralysis & sedation


Transfers performed

Phenobarbitone use


Transfers performed

Inotropic support


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