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WMNTS Activity

This operational policy outlines the services provided by the Neonatal Transfer Services (WMNTS) from April 2012 to March 2013. The services include 24/7 retrieval service, daily back transfer service, and cot locator service from neonatal units. The policy also covers data collection, types of transfers, staffing, clinical incidents, budget, and changes.

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WMNTS Activity

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  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

  10. 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)

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

  12. Data Collection April 12-Dec 12

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

  14. Medical Transfers 12-13

  15. Cardiac Transfers

  16. Surgical 12-13

  17. Surgical Transfers

  18. Specialist 12-13

  19. Back Transfers 12-13

  20. Cot Management

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

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

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

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

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

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

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

  28. Example – March 2013

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

  30. 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

  31. Time Critical Transfers

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

  33. 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)

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

  35. Geographical Area Covered

  36. Travelling times from Base Hospital

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

  38. Staffing

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

  40. Clinical Incidents

  41. Comparison of Incidents

  42. Types of Incidents

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

  44. Budget

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

  46. Developments over the last 6 months

  47. 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

  48. Ambulance Driver Training

  49. New Ambulances

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