WMNTS Activity

1. WMNTS Activity April 2012-March 2013

2. Who We Are

3. 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

4. Transfer numbers • Refusals • Data collection • Types of Transfers • Time critical transfers • Staffing • Clinical Incidents • Budget • Changes

5. Transfer numbers • Refusals • Data collection • Types of Transfers • Time critical transfers • Staffing • Clinical Incidents • Budget • Changes

6. Transfers 2009-2013

7. Activity 2012-13

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

9. Transfer numbers • Refusals • Data collection • Types of Transfers • Time critical transfers • Staffing • Clinical Incidents • Budget • Changes

11. 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)

12. Transfer numbers • Refusals • Data collection - old • Types of Transfers • Time critical transfers • Staffing • Budget • Clinical Incidents • Changes

13. Data Collection April 12-Dec 12

14. Transfer numbers • Refusals • Data collection • Types of Transfers - old • Time critical transfers • Staffing • Clinical Incidents • Budget • Changes

15. Medical Transfers 12-13

16. Cardiac Transfers

17. Surgical 12-13

18. Surgical Transfers

19. Specialist 12-13

20. Back Transfers 12-13

21. Cot Management

22. Transfer numbers • Refusals • Data collection - new • Types of Transfers • Time critical transfers • Staffing • Clinical Incidents • Budget • Changes

23. Since Jan 13 Replaced by a 4-level categorisation • EVERY inter-hospital neonatal transfer categorised against these categories.

24. BAPM category of care Pick ONE Notes: Transitional care / normal care not included as basic monitoring used for all babies in transfer

25. Primary clinical reason for transfer Pick ONE Categorise on the intended treatment the infant will receive on completion of transfer.

26. Primary operational reason for transfer Pick ONE Notes: Uplift: Transfer for care that the referring centre does not normally offer

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

28. Transfer numbers • Refusals • Data collection • Types of Transfers - new • Time critical transfers • Staffing • Clinical Incidents • Budget • Changes

29. Example – March 2013

30. Transfer numbers • Refusals • Data collection • Types of Transfers • Time critical transfers • Staffing • Clinical Incidents • Budget • Changes

31. 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

32. Time Critical Transfers

33. Types of Time Critical Transfers No CHD not responding to prostaglandin infusion (4) ; No (5) recorded

34. 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)

35. Dispatch <1 hour 1 transfer performed for CenTre; 1 transfer performed by KIDS as WMNTS oncall

36. Geographical Area Covered

37. Travelling times from Base Hospital

38. Transfer numbers • Refusals • Data collection • Types of Transfers • Time critical transfers • Staffing • Clinical Incidents • Budget • Changes

39. Staffing

40. Transfer numbers • Refusals • Data collection • Types of Transfers • Time critical transfers • Staffing • Clinical Incidents • Budget • Changes

41. Clinical Incidents

42. Comparison of Incidents

43. Types of Incidents

44. Transfer numbers • Refusals • Data collection • Types of Transfers • Time critical transfers • Staffing • Clinical Incidents • Budget • Changes

45. Budget

46. Transfer numbers • Refusals • Data collection • Types of Transfers • Time critical transfers • Staffing • Clinical Incident • Budget • Changes

47. Developments over the last 6 months

48. 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

49. Ambulance Driver Training

50. New Ambulances