Neonatal and Paediatric Critical Care Transfer System Implementation Project
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Neonatal and Paediatric Critical Care Transfer System Implementation Project (Yorkshire and the Humber). Michelle Milner Project Manager. Current service configuration:- Neonatal.

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Neonatal and Paediatric Critical Care Transfer System Implementation Project (Yorkshire and the Humber)

Michelle Milner

Project Manager


Current service configuration neonatal l.jpg
Current service configuration:- Neonatal Implementation Project

  • NIC services – investment of around £750k but neither service is able to provide a 24 hour service 365 days per year.

  • Both current services for neonates support nurse led transfers for non acute patients

  • Both neonatal services reliant on middle grade medical staff for the provision of out of hour and acute neonatal transfers

  • Both Networks have invested in ANNPs, however, not all acute transfers can be carried out without middle grade support


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Current service configuration:- PIC Implementation Project

  • 2 PIC services in LTHT and SCH

  • Both are similar with no additional resources to support a separate retrieval service to bed base

  • Therefore if a bed & staff there will be a transfer – no bed / no staff means that the PIC services can not transfer child


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Risks Implementation Project

  • Impact of EWTD and medical training

  • Sustainability of current services

  • DGH risks associated with lengthy wait for transfer and requirement to transfer when a team not available

  • Unmet need for HD children particularly cardiac and surgical

  • Current problems with out of hours services for neonatal transfers resulting in secondary care services holding onto babies until transport teams are available

  • Reconfiguration of services can not occur without a comprehensive transport infrastructure


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Background and work so far Implementation Project

  • Project commenced two years ago to establish a transport service for Yorkshire and the Humber region for children and neonates

  • Project steering group reports to SCG as project board for the implementation of service

  • Developed a service specification describing the standards and requirements of the new service

  • SCG have agreed to support an internal collaborative arrangement with the three current provider organisations to deliver the new service by August 2009


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What will the new service look like Implementation Project

  • One telephone access

  • Call centre where all calls are able to be recorded and where there is a facility to deliver call conferencing between referring units, receiving units, sub specialty consultants and transport team

  • Team located centrally between Sheffield and Leeds

  • Four day time teams to carry out acute transfers, non acute neonatal transfers and back transfers

  • One night time team for acute transfers with a second on call consultant team if required

  • Driver crew forming part of the transport team and located with the team

  • Vehicles separate from the YAS emergency fleet


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Who will the new service transfer:- Implementation Project

  • All neonates requiring transfer between hospital sites (acute and non acute)

  • Critically ill children requiring both PIC and HD care (regardless of whether there is a bed within the region)

  • Acute patients requiring specialist out of region services e.g. burns, cardiac and ECMO

  • Critically ill neonates and children, requiring acute transfer from out of region units, at times of high demand when there is no capacity in their local facility

  • Cardiology patients requiring out of region for speciality services

  • PICUs in Leeds and Sheffield for back transfers

  • Neonates and children requiring repatriation back to a local unit for ongoing management following intensive care


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Advice calls:- Implementation Project

The transport service will accept calls for advice for the following types of transfer:-

  • Non critical care inter-hospital transfers of children

  • Rapid response helicopter / air ambulance emergency transfers between secondary and tertiary care

  • Time critical patients (head injury, blocked VP shunts etc)


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Exclusions:- Implementation Project

  • Adult transfers

  • Fixed wing and helicopter transfers

  • “Primary response” transfers

  • Inter hospital transfers


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Summary of 2006/7 transfers Implementation Project


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Summary of all transfers by month Implementation Project


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Transfers by time of day Implementation Project


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Call centre standards:- Implementation Project

  • Will log and record all calls

  • Will take initial details of caller, provide details of available beds to obstetricians and pass on all requests for transfer to either nurse co-ordinator for planned transfers or consultant for acute transfers

  • Will establish call conferencing with referring unit, accepting unit, consultant for transport and transfer team and any other specialist as appropriate

  • Will work within patient flow algorithms to determine most appropriate destination of patient

  • Will audit all transfer requests and details of transfers to provide data on the service activity


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Referring Neonatal Unit Implementation Project

If no bed

Neonatal

Other specialist cardiac centre

Cardiac (All)

Back

transfers

To nearest unit in geographical distance to home

Leeds

Neonatal surgical

Level 3 tertiary care

Movement of babies for intensive care

York

Harrogate

Mid-Yorks

Bradford

Airedale

Calderdale

to

Leeds

Scar-borough

to

Hull

Airedale

Calderdale

to

Bradford

Jessops Wing

Barnsley

Bassetlaw

Chesterfield

Doncaster

Grimsby

Rotherham

Scunthorpe

to

Sheffield

Children's

York

Harrogate

Pontefract

Dewsbury

to

Leeds

Barnsley

Bassetlaw

Chesterfield

Doncaster

Grimsby

Rotherham

Scunthorpe

to

Sheffield Jessops Wing

The movement of babies to meet neonatal standards will be determined by geographical distance from the babies home location to provide care as close to home as possible.

Scar-borough

to

Hull


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Referring Unit for PCC Implementation Project

Burns requiring ventilation to Manchester or Liverpool all other burns patients to appropriate centre's

Transfer out of cardiac patients for specialised services

Acute PCC

Back transfers from PICU

From Leeds or Sheffield to nearest unit in geographical distance to home

Bradford

Airedale

Calderdale

Mid-Yorks

Northallerton

Harrogate

York

Scarborough

Hull

to

Leeds

Barnsley

Bassetlaw

Chesterfield

Doncaster

Grimsby

Rotherham

Scunthorpe

to

Sheffield

Children's

Leeds Cardiology

to

Great Ormond Street

Guys Hospital

Birmingham Children’s or other external cardiology service

for specialist services

If

P

I

C

U

full

If both PICUs full transfer to out of region PICU e.g. Nottingham Manchester etc.


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Clinical care staff:- Implementation Project

24 hour consultant cover – day time consultant cover and on call night time cover

  • Consultants with either Neonatology, Paediatric Intensive Care, Anaesthesia or Paediatric Emergency Medicine background

  • Certified providers of APLS, NLS and PanSTAR, or be prepared to undertake this training.

    24 hour middle grade cover

  • Trainees will be Specialty Training Registrars (StRs) at ST6 or above, who have completed core training.

  • 8 person rota

    Nursing:- Permanent / rotational / secondment staff

  • One lead nurse

  • Advanced nurse practitioners

  • Senior transport nurses

  • Rotational / secondment nurses

    4 day time teams of nurses (includes ANP nurses)

    2 night time teams of nurses


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Vehicle and crew provision Implementation Project

  • Four vehicles – set up using SCH specification

  • One / two being charitably donated

  • YAS contract for provision and servicing of vehicles

  • Driver crews – a team of drivers located with team (four each day and two each night), blue light trained, non clinical, single driver per vehicle


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Where are we now with implementation project Implementation Project

Lead provider agreed – SCH

Working up a timetable for implementation

Three sub groups:-

  • Clinical care group

  • Service development group

  • Vehicle provision group

    Will develop a Transport Service Management Board


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Agree job descriptions Implementation Project

Develop process for consultant appointments

Develop process for middle grade staffing agreement with Deanery

Produce operational guidelines

Produce competency training programme

Produce documentation for use in service

Develop a list of equipment and consumables required

Clinical care sub group:-


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Service development group:- Implementation Project

  • Agree implementation timescales

  • Agree location of team

  • Agree TUPE requirements for current staff and timescales

  • Determine call centre location e.g. with team location or sub contracted through YAS call centre

  • Develop and agree service level agreement with lead provider

  • Work up service contracts with lead provider


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Vehicle provision:- Implementation Project

  • Agree resource requirements for vehicle and driver provision

  • Develop timescales for recruitment of drivers

  • Develop training programme for drivers

  • Agree timescales for vehicle provision

  • Develop service level agreement against detailed specification

  • Agree alterations to current contract arrangements


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Any questions?? Implementation Project