Experiences and Lessons from the North West Perinatal Cot Bureau

1. Experiences and Lessons from the North West Perinatal Cot Bureau Viviane Hall Lead Nurse GMNeTS

2. Aim Background Operational aspects of the Cot Bureau Referral processes Data Collection The Future Summary

3. Background Historically ad hoc systems for arranging antenatal transfer Time consuming for Maternity staff Frequent difficulties in placement of high risk infants CESDI (project 27/28) suggested that 1 in 4 mothers required transfer before delivery, clinical care was substandard in 7% and organisational process in 21%

4. Main Proposals Greater Manchester Perinatal Cot Bureau Telephone Hotline for acute referrals A dedicated Neonatal Transport Team A “complete” Neonatal transport service for Greater Manchester Progression from Medical to ANNP led retrievals Rapid response service for level 1 Units

5. Implementation MCN working party for transport Business case and option appraisal 2004 Agreed by MCN,SHA,PCT’s and GMAS Funded from GM MCN monies

6. Location and Ownership of Service Transport service commenced March 2005 Perinatal cot bureau and transport team based at St Marys Hospital Project funded by Neonatal MCN for whole of Greater Manchester All inter-hospital transfers undertaken Cot Bureau operates according to MCN agreed referral guidelines

7. Functions of the Perinatal Cot Bureau (1)Information gathering Contact each unit 3 times per day for intensive, high dependency and special care cot availability Maintain a 24/7 database of Neonatal Cot availability across Greater Manchester Link to proposed national database of level 3 unit intensive care cot availability Support MCN wide perinatal transport audit

8. Functions of the Perinatal Cot Bureau (2) Telephone Hotline To act as first point of contact for all acute antenatal and postnatal referrals To gather identification and brief clinical details To liaise with clinical staff and transport team To liaise with ambulance service To keep all parties informed of the transfer status Maintain a record of all transfers

9. Functions of the Perinatal Cot Bureau (3) Scheduling planned transfers To facilitate and schedule planned non-acute transfers To compile daily worklist of planned transfers To liaise with clinical staff and arrange transfers for outpatient appointments and day cases To liaise with ambulance service To keep all parties informed of transfer status

10. Staffing 2 WTE administrators A&C grade 3(will join existing operational support officers) 24/7 Cover Supervision by office manager, lead transport nurse and clinical director for transport

11. Referral enquiry Antenatal Postnatal Transfer To CDU Transfer to Postnatal Ward Acute Non-acute Intensive special Back transfer Daycase Admission Clinic

12. Draft referral guidelines – an example for discussionAntenatal transfer from a level 1 unit at <28 weeks gestation Primary Action • Refer to nearest level 3 / 4 unit Secondary actions • Refer to other level 3 / 4 units in Manchester and within 50 mile radius in order of proximity Safety net • If delivery anticipated >25 weeks and no level 3 / 4 unit available within 50 mile radius, consider maternal transfer to nearest level 2 unit in Manchester • If 25 weeks or less, and delivery not imminent, arrange transfer to nearest level 3 / 4 unit outside 50 mile radius • If delivery becomes imminent, continue to attempt to locate intensive care cot for a postnatal transfer and ensure appropriate neonatal support • If gestation < 23 weeks or very poor prognosis consider local delivery with appropriate neonatal support

13. Practical details (1)Information requested on cot availability Telephone call to Senior nurse on duty at 08.00, 14.00 and 21.00 Number of Intensive, High Dependency and Special Care infants on unit. Number of qualified staff on shift Is unit fully open (Green), closed (Red) or open to certain intensive care categories (Amber) Reason for closure Expected admissions and discharges Is admission status expected to change Units should contact cot bureau if status changes

14. Practical details (2)Information requested on referral enquiry Referrersdetails Antenatalorpostnatalrequest Infantand Maternalidentifiers Typeofreferral GestationandWeight Infantproblems Urgencyoftransfer Comments

15. Practical details (3)Communications 1 dedicated telephone (Hotline) Hotline phone is portable and transferable All referrals recorded Conference calling facilities for complex patients e.g. ECMO referral

16. Greater Manchester Maternity and Neonatal Network

17. Antenatal Transfers (IUTs) Total 466 A/N transfer requests (June 1st 2011- May 31st 2012) 266 Greater Manchester 65 Lancashire and South Cumbria 24 Could not be placed immediately 27 Arranged transfers subsequently cancelled 55 Declined due to Network capacity

18. Transfer Types

19. Out of Network Transfers

20. Data Collection Reasons for Antenatal Transfer Reasons for Acute/Planned transfers Activity Levels Dependency Levels Staffing Levels Referral Times Cooling Data Evidence

21. Ongoing Developments Network Status Staffing variance (%) BAPM Network Back Transfer Guideline Fibronectin Testing

22. Summary Cot bureau deals with antenatal and all postnatal enquiries It provides a 24/7 service Dedicated telephone hotline Close liaison between Cot bureau, transport team, referring / receiving clinicians and ambulance service Up to date Network status Ongoing data collection

23. Any Questions?