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West Midlands Neonatal Transfer Service WMNTS Activity April 2012-March 2013.

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Presentation on theme: "West Midlands Neonatal Transfer Service WMNTS Activity April 2012-March 2013."— Presentation transcript:

1 West Midlands Neonatal Transfer Service WMNTS Activity April 2012-March 2013

2 Who We Are

3 West Midlands Neonatal Transfer Service 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 West Midlands Neonatal Transfer Service Transfers 2009-2013

7 West Midlands Neonatal Transfer Service Activity 2012-13

8 West Midlands Neonatal Transfer Service 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

10 REASON FOR NOT UNDERTAKING TRANSFERS Attributable to NTSNon NTS Number of RefusalsStaffing On other/ ITU calls Weather/ Equipment Deterioration of baby No bedsParents Inapprop request Canc by ref unit Not in our network Canc by rec unit SWMNN 716233 20 19 SSBCNN 34154 12 3 CNN 15 1 14 Other 71 3 3 Total 127 Number of Cancellations SWMNN 139 40 103543 111 SSBCNN 46 5 31721 1 CNN 10 1 15 21 Other 17 751 3 1 Total 212 Number of Deferrals SWMNN 17 111121 1 SSBCNN 8 7 1 CNN 0 Other 3 1 11 Total 28 229242367839574114

11 West Midlands Neonatal Transfer Service 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 West Midlands Neonatal Transfer Service Data Collection April 12-Dec 12 TransferredIPPVSurgicalCardiac Back transferSpecialist OPD/ Radiology Cot MngtCooling

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

15 West Midlands Neonatal Transfer Service Medical Transfers 12-13

16 West Midlands Neonatal Transfer Service Cardiac Transfers

17 West Midlands Neonatal Transfer Service Surgical 12-13

18 West Midlands Neonatal Transfer Service Surgical Transfers

19 West Midlands Neonatal Transfer Service Specialist 12-13

20 West Midlands Neonatal Transfer Service Back Transfers 12-13

21 West Midlands Neonatal Transfer Service 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 West Midlands Neonatal Transfer Service BAPM category of care Intensive CareHigh dependency care Special care Pick ONE Notes: Transitional care / normal care not included as basic monitoring used for all babies in transfer

25 West Midlands Neonatal Transfer Service Primary clinical reason for transfer MedicalSurgicalCardiacNeurological Pick ONE Categorise on the intended treatment the infant will receive on completion of transfer.

26 West Midlands Neonatal Transfer Service Primary operational reason for transfer UpliftResources/ Capacity RepatriationOutpatients Pick ONE Notes: Uplift: Transfer for care that the referring centre does not normally offer

27 West Midlands Neonatal Transfer Service Time Within 1 hourWithin 24 hours >24 hours 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 ITU34Uplift41 HD14Capacity13 SC39Repatriation33 Out Patients0 Medical56 Surgical22Within 1 hr2 Cardiac1Within 4 hrs37 Neuro /cooling8 (1+7)Within 24 hrs47 >24 hours1

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

31 West Midlands Neonatal Transfer Service Clinical criteria for categorising as Time Critical 1. Gastroschisis 2. Ventilated infant with Tracheo-oesophageal fistula +/- atresia 3. Intestinal perforation 4. Suspected duct-dependent cardiac lesion not responding to prostin 5. Unstable respiratory or cardiovascular failure not responding to appropriate management: Despite giving appropriate ventilation via endotracheal tube the infants respiratory status remains unstable or severely compromised: persistent unstable pneumothorax despite chest drain requiring FiO 2 100% arterial oxygen < 5kPa on 2 consecutive blood gas measurements pH 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)

32 Time Critical Transfers NIC01 - WMNTS Transfer Response Time Response Times*or if born >same day, time call received DateDiagnosis Referring Hospital Receiving HospitalVent mode Time Baby Born Time call received Time call accepted Time team left base Miles to ref unit Arrived ref hospital Miles to rec unit Depart ref hospital Arrived rec hospital Total time (time born* - rec hosp)Comments 20.04.12Perforated NECHeartlandsAlder Hey PICUIMV09:0415:5015:5516:15816:409818:3520:2011hrs 16mins Alderhey PICU bed lost upon arrival; theatre bed made available after 1.5 hours 30.04.12GastroschisisB'ham Women'sBCH NNSUSVIA11:2511:55 12:05012:10413:2513:552hrs 30mins Delay due to haematoma requiring Consultant review. Roadworks delayed journey outside BCH, Consultant in theatre when team arrived 06.05.12GastroschisisB'ham Women'sBCH NNSUSVIA12:5913:40 013:45414:5015:152hrs 16mins 13.05.12GastroschisisB'ham Women'sBCH NNSUSVIA10:4412:5014:15 Team finished moving other baby from BCH to BWH 14:45014:45415:3015:505hrs 6mins WMNTS had to move a baby from BCH NNSU first to create cot space for this baby, therefore not able to obtain surgical review within 2 hour timeframe. 14.05.12 RDS, Perforated NECUHNSAlder HeyIMV On 8.05.1215:15 16:006617:255519:3520:405hrs 25mins Team already out on transfer (Redditch) when call received, ambulance needed to be swapped due to broken door. Delay on motorway due to major incident, police contacted for alternative route 18.05.12Perforated NECUHNSBCH PICUSIMV On 13.05.1218:50 4920:004521:4022:403hrs 50minsOutcome - no perforation, treated conservatively 25.06.12Perforated NECHeartlandsBCH PICUIMVOn 19.06.1206:3507:5508:25809:00410:0510:253hrs 50mins Baby being intubated at the time of first call, handed over to day team 30.06.12GastroschisisShrewsburyAlder Hey PICUSVIA00:2201:25 00:30*5201:307003:4005:154hrs 53mins *Team already on site for another transfer, hence time team left base prior to time call received 19.07.12GastroschisisB'ham Women'sBCH NNSUSVIA20:2021:15 21:20021:35422:2022:402hrs 20mins 21.07.12GastroschisisHeartlandsBCH PICUIMV09:4710:0510:1010:30810:55412:4513:053hrs 18mins Baby not ready and awaited confirmation of PICU cot 29.07.12Perforated NECCity Dudley RdBCH PICUIMV On 05.06.1214:0014:1514:30414:45316:2516:452hrs 45mins Baby hypothermic due to need for emergency abdo drain insertion. Very unstable baby. RIP 29/07/2012 nothing for August 05.09.12Perforated NECHeartlandsBCH PICUIMV On 31.08.1219:20 20:25820:45322:4023:103hrs 50mins 13.09.12GastroschisisB'ham Women'sBCH NNSUSVIA11:1512:00 0 412:5013:202hrs 5 mins 09.10.12?Perforated NECNew CrossBCH PICUIMV On 06.09.1212:15 12:401613:301615:0015:303hrs 15mins 16.10.12GastroschisisWalsall ManorBCH NNSUSV 0217:1917:00 2417:451219:2519:502hrs 31minsTeam diverted from Heartlands transfer 01.11.12TOFWalsall ManorBCH PICUIMV00:4510:1010:1510:551311:401213:1514:0013hrs 15minsCall not received by NTS until 1010hrs 17.11.12GastroschisisB'ham Women'sBCH NNSUSVA00:2501:10 02:200 403:0003:303hrs 5mins Call received during on call hours, staff came in from home (1 hour approximately to travel to workplace from home) 18.11.12?Perforated NECNew CrossBCH PICUIMV/NOOn 14.11.1223:4023:5000:401601:151602:4003:306hrs 24mins Call received during on call hours, staff came in from home (1 hour approximately to travel to workplace from home) 22.11.12 ?TOF - duodenal atresiaHeartlandsBCH PICUIMV07:0013:30 14:30815:05316:5518:0011hrsBed not available on PICU until 1600hrs 24.12.12GastroschisisB'ham Women'sBCH NNSUInc0213:3714:45 0 416:0016:302hrs 55minsWMNTS not contacted immediately 02.01.13GastroschisisB'ham Women'sBCH PICUIMV05:0205:45 06:40006:45409:0009:203hrs 18mins Call received during on call hours, staff came in from home but baby intubated and required PICU bed, handed over to day team whilst awaiting confirmation of bed 07.01.13GastroschisisB'ham Women'sBCH NNSWNP0218:0519:20 19:300 420:2020:402hrs 35 mins 22.01.13Perforated NECShrewsburyLiverpoolIMVunknown13:10 14:455215:256916:3018:305hrs 20 minsTime recorded from when call received as time baby born not available 01.02.13?PerforationB'ham Women'sBCH PICUIMV On 28.01.1312:25 012:30415:2515:553hrs 30minsBaby not ready, required intubation and x-ray 05.02.13?Perforated NECHeartlandsBCH PICUIMV On 04.01.1304:40 05:45806:05308:1008:253hrs 45 minsCall received during on call hours 15.02.13GastroschsisNew CrossBCH PICUSIMV12:4813:20 13:451614:401616:0016:403hrs 52minsBed not confirmed at time of referral (confirmed at 13:45) 20.02.13Intestinal perforationUHNSAlder Hey PICUIMV On 16.02.1316:0016:1016:355418:005519:3020:454hrs 45minsDelay at Alder Hey waiting for baby to go into theatre 27.03.13GastroschisisB'ham Women'sBCH NNSUSVIA10:1711:4011:4512:40012:50413:5014:053hrs 48mins Delay due to baby not yet fully admitted to NNU and no discharge paperwork available 28.03.13?Intestinal perforationWalsgraveBCH PICUIMVOn 16.03.1315:2015:3015:453016:202617:5518:553hrs 35minsPerforming transfer on behalf of CenTre team

33 West Midlands Neonatal Transfer Service Types of Time Critical Transfers No CHD not responding to prostaglandin infusion (4) ; No (5) recorded

34 West Midlands Neonatal Transfer Service 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 West Midlands Neonatal Transfer Service Dispatch <1 hour 1 transfer performed for CenTre; 1 transfer performed by KIDS as WMNTS oncall

36 Geographical Area Covered

37 West Midlands Neonatal Transfer Service Travelling times from Base Hospital Time (mins) City18 BCH19 BHH24 Russells Hall 26 Redditch28 Walsall30 Time (mins) Good Hope31 Worcester34 New Cross36 Stafford54 UHNS67 Hereford70 Shrewsbury74

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

39 West Midlands Neonatal Transfer Service Staffing FundingActual Consultant 1.3 (0.9, 0.2, 0.3)1.2 Nurse Consultant (8c) 11 ANNP (mid point 8b) 83 + 1 secondment ( + 0.5 8a) ST6 0Approx 0.5 Band 6 nurses 85.0 (3 vacancies advertised) Band 4 11 Band 2 (cot locator) 11

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

41 West Midlands Neonatal Transfer Service Clinical Incidents

42 West Midlands Neonatal Transfer Service 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 West Midlands Neonatal Transfer Service Developments over the last 6 months

48 West Midlands Neonatal Transfer Service 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 West Midlands Neonatal Transfer Service Ambulance Driver Training

50 West Midlands Neonatal Transfer Service New Ambulances

51 West Midlands Neonatal Transfer Service

52 West Midlands Neonatal Transfer Service Parents Travelling with Babies

53 West Midlands Neonatal Transfer Service Tecotherm Mattress & Trolley

54 West Midlands Neonatal Transfer Service WMNTS Objectives 2013-14

55 Objective 1: To meet Continuing Professional Development requirements in neonatal transport Reference Network Objectives Work ProgrammeMeasurement UsedLeadReview Date Progress Review April 2014 SSBCNN Objective 3 SWMNN Objective 4 Toolkit 5 Continue to provide training on Transfer medicine to multi- professional staff in the networks Attendance record at bi- annual study days, ST Deanery training programme, QIS programme Alex Philpott Jackie Harrison On going To provide outreach programs for Units in the networks Service delivery, supporting network study days, training packages on web site Alex Philpott Jackie Harrison On going To ensure educational needs for WMNTS staff pertaining to neonatal transport are met Rolling programme for all WMNTS staff to complete accredited transport course Alex Philpott Jackie Harrison On going Bespoke training to WMAS prehospital neonatal providers Bespoke training delivered to support regional MLUs/paramedics Alex PhilpottApr-14

56 Objective 2: Promote the activities and share the experiences of the NTS with others Reference Network Objectives Work ProgrammeMeasurement UsedLeadReview Date Progress Review April 2014 SSBCNN Objective 1 SWMNN Objective 1, 2 Toolkit 7.8 + 7.12 Quarterly data to include risk assessment / Near Miss Report to be generated to each unit and Network Board Jackie HarrisonQ3,4,1,2 Minimise the number of out of region transfers in particular for surgical management Report to be generated to each unit and Network Board Jackie HarrisonQ3,4,1,2 Monitor and audit babies transferred for cooling Report to be generated to each unit and Network Board Q3,4,1,2 Present data to Transfer User Group Jackie HarrisonJune 13, Jan 14 Education workstream to be trained in simulation medicine Record of completion of training for 3 team members; record of participation in network simulations Alex PhilpottJune 13, Jan 14 Monitor and audit time critical transfers Present data to Transfer User Group Jackie HarrisonJune 13, Jan 14

57 Objective 3: To deliver a safe transport service which meets the needs of neonatal services in the West Midlands Reference Network Objectives Work ProgrammeMeasurement UsedLeadReview Date Progress Review April 2014 SSBCNN Objective 2, 3 SWMNN Objective 6 Continue to support units initiate therapeutic hypothermia Service delivery Attendance record Jackie Harrison/ WMNTS Cooling lead Dec-13 To perform user satisfaction questionnaire Audit presented at Transfer User Group Alex Philpott Jackie Harrison June 13, Jan 14 Training in use of Tecother Mattress and transport device WMNTS Training record Alex Philpott Jackie Harrison Jun-13 To provide a transport service for neonatal palliative care referrals Record kept of palliative care transfers Alex Philpott Jackie Harrison Apr-14

58 Objective 4: To ensure the NTS is appropriately resourced for all neonatal transport activity Reference Network Objectives Work ProgrammeMeasurement UsedLeadReview Date Progress Review April 2014 SSBCNN Objective 3 SWMNN Objective 2 24 hour dedicated call handling centre Option appraisal for establishment of call handling centre completed Alex Philpott Jackie Harrison Dec-13 Toolkit 4.5 Ensure an adequate number of appropriately trained personnel for NTS by support of student ANNPs and rotation into neonatal units Monitor staffing levels;Alex PhilpottOngoing Supporting ST Training during rotation into NTS ST training programme and feedback from ST Alex Philpott Ongoing

59 West Midlands Neonatal Transfer Service Terms of Reference

60 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.

61 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

62 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

63 West Midlands Neonatal Transfer Service National Transport Group Conference 2013 Friday 29 th November 2013 Burlington Hotel Birmingham B2 4JQ Programme of Events Welcome Chairmans report The Challenges of Neonates for a Paediatric Intensive Care Retrieval Service The Australian Transport Service The Parents Perspective Guest Speaker Poster Presentations Close Hosted by: Abstracts Authors are invited to submit audit or research abstracts to jane.edwards@bwhct.nhs.uk (see separate application form)jane.edwards@bwhct.nhs.uk 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 30 th September 2013 Accepted admissions to be notified by 18 th 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

64 West Midlands Neonatal Transfer Service

65 West Midlands Neonatal Transfer Service

66 West Midlands Neonatal Transfer Service

67 West Midlands Neonatal Transfer Service

68 West Midlands Neonatal Transfer Service Cooling Activity April 2012 ~ March 2013

69 West Midlands Neonatal Transfer Service Requests from

70 West Midlands Neonatal Transfer Service Transfers requests Per network 17 32 2

71 West Midlands Neonatal Transfer Service Transfer To

72 West Midlands Neonatal Transfer Service 17 14 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

73 West Midlands Neonatal Transfer Service Transfers performed Referral age

74 West Midlands Neonatal Transfer Service Transfers performed Response time (Call Arrival on Ref. NNU)

75 West Midlands Neonatal Transfer Service Transfers performed Age at Cooling centre

76 West Midlands Neonatal Transfer Service Transfers performed Age 33-34°C Achieved

77 West Midlands Neonatal Transfer Service Transfers performed Methods of cooling

78 West Midlands Neonatal Transfer Service Transfers performed Babies not cooled

79 West Midlands Neonatal Transfer Service Transfers performed Ventilatory support

80 West Midlands Neonatal Transfer Service Transfers performed Paralysis & sedation

81 West Midlands Neonatal Transfer Service Transfers performed Phenobarbitone use

82 West Midlands Neonatal Transfer Service Transfers performed Inotropic support


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