WMNTS Activity

WMNTS Transfers

WMNTS ActivityApril 2012-March 2013West Midlands Neonatal Transfer Service

Who We Are

West Midlands Neonatal Transfer Service

Note the lack of men although we have 6 male ambulance drivers, 1 male Grid trainee and 0.5 (2) male consultantsOperational PolicyProvide 24/7 retrieval serviceProvide daily back transfer service9-5 Monday-Friday cot locator service

Retrieve from neonatal units or neonates from BCH/Alder HeyWest Midlands Neonatal Transfer Service

Transfer numbersRefusalsData collectionTypes of TransfersTime critical transfersStaffingClinical IncidentsBudgetChanges




Transfers 2009-2013West Midlands Neonatal Transfer Service

Activity 2012-13West Midlands Neonatal Transfer Service

Other includes repatriation from LWH, Alder Hey, Bristol(s), Arrowe Park)West Midlands Neonatal Transfer Service

8Transfer numbersRefusalsData collectionTypes of TransfersTime critical transfersStaffingClinical IncidentsBudgetChanges


REASON FOR NOT UNDERTAKING TRANSFERSAttributable to NTSNon NTSNumber of RefusalsStaffingOn other/ITU callsWeather/EquipmentDeteriorationof babyNo bedsParentsInapproprequestCanc byref unitNot in ournetworkCanc by rec unitSWMNN7162332019SSBCNN34154123CNN15114Other7133Total127Number of CancellationsSWMNN1394010354335111SSBCNN46531721171CNN1011521Other1775131Total212Number of DeferralsSWMNN171111211SSBCNN871CNN0Other3111Total28229242367839574114West 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)West Midlands Neonatal Transfer Service

Transfer numbersRefusalsData collection - oldTypes of TransfersTime critical transfersStaffingBudgetClinical IncidentsChanges


Data Collection April 12-Dec 12TransferredIPPVSurgicalCardiacBacktransferSpecialistOPD/RadiologyCotMngtCoolingWest Midlands Neonatal Transfer Service

Transfer numbersRefusalsData collectionTypes of Transfers - oldTime critical transfersStaffingClinical IncidentsBudgetChanges


Medical Transfers 12-13West Midlands Neonatal Transfer Service

Cardiac TransfersWest Midlands Neonatal Transfer Service

Surgical 12-13West Midlands Neonatal Transfer Service

Surgical TransfersWest Midlands Neonatal Transfer Service

Specialist 12-13West Midlands Neonatal Transfer Service

Back Transfers 12-13West Midlands Neonatal Transfer Service

Cot ManagementWest Midlands Neonatal Transfer Service

Transfer numbersRefusalsData collection - newTypes of TransfersTime critical transfersStaffingClinical IncidentsBudgetChanges


Since Jan 13Replaced by a 4-level categorisation

EVERY inter-hospital neonatal transfer categorised against these categories.


BAPM category of careIntensive CareHigh dependency careSpecial carePick ONE

Notes: Transitional care / normal care not included as basic monitoring used for all babies in transfer West Midlands Neonatal Transfer Service

Primary clinical reason for transferMedicalSurgicalCardiacNeurologicalPick ONE

Categorise on the intended treatment the infant will receive on completion of transfer. West Midlands Neonatal Transfer Service

Primary operational reason for transferUpliftResources/CapacityRepatriationOutpatientsPick ONENotes:Uplift: Transfer for care that the referring centre does not normally offerWest Midlands Neonatal Transfer Service

TimeWithin 1 hourWithin 24 hours>24 hoursPick ONE

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


Transfer numbersRefusalsData collectionTypes of Transfers - newTime critical transfersStaffingClinical IncidentsBudgetChanges


Example March 2013ITU34Uplift41HD14Capacity13SC39Repatriation33Out Patients0Medical56Surgical22Within 1 hr2Cardiac1Within 4 hrs37Neuro /cooling8 (1+7)Within 24 hrs47>24 hours1West Midlands Neonatal Transfer Service



Clinical criteria for categorising as Time CriticalGastroschisisVentilated infant with Tracheo-oesophageal fistula +/- atresiaIntestinal perforationSuspected duct-dependent cardiac lesion not responding to prostinUnstable 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 FiO2 100%arterial oxygen < 5kPa on 2 consecutive blood gas measurementspH 9kPa persistent mean blood pressure below corrected gestational age, measured on arterial line; if measured with cuff only, there should also be acidosis (pH same day, time call receivedDateDiagnosisReferring HospitalReceiving HospitalVent modeTime Baby BornTime callreceivedTime callacceptedTime team left baseMiles toref unitArrived refhospitalMiles to rec unitDepart refhospitalArrived rechospitalTotal time (time born* - rec hosp)Comments20.04.12Perforated NECHeartlandsAlder Hey PICUIMV09:0415:5015:5516:15816:409818:3520:2011hrs 16minsAlderhey PICU bed lost upon arrival;theatre bed made available after 1.5 hours30.04.12GastroschisisB'ham Women'sBCH NNSUSVIA11:2511:5511:5512:05012:10413:2513:552hrs 30minsDelay due to haematoma requiring Consultant review. Roadworks delayed journey outside BCH, Consultant in theatre when team arrived06.05.12GastroschisisB'ham Women'sBCH NNSUSVIA12:5913:4013:4013:40013:45414:5015:152hrs 16mins13.05.12GastroschisisB'ham Women'sBCH NNSUSVIA10:4412:5014:15Team finished moving other baby from BCH to BWH14:45014:45415:3015:505hrs 6minsWMNTS 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.14.05.12RDS,Perforated NECUHNSAlder HeyIMVOn8.05.1215:1515:1516:006617:255519:3520:405hrs 25minsTeam 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 route18.05.12Perforated NECUHNSBCH PICUSIMVOn13.05.1218:5018:5018:504920:004521:4022:403hrs 50minsOutcome - no perforation, treated conservatively25.06.12Perforated NECHeartlandsBCH PICUIMVOn 19.06.1206:3507:5508:25809:00410:0510:253hrs 50minsBaby being intubated at the time of first call,handed over to day team30.06.12GastroschisisShrewsburyAlder Hey PICUSVIA00:2201:2501:2500:30*5201:307003:4005:154hrs 53mins*Team already on site for another transfer, hencetime team left base prior to time call received19.07.12GastroschisisB'ham Women'sBCH NNSUSVIA20:2021:1521:1521:20021:35422:2022:402hrs 20mins21.07.12GastroschisisHeartlandsBCH PICUIMV09:4710:0510:1010:30810:55412:4513:053hrs 18minsBaby not ready and awaited confirmation ofPICU cot29.07.12Perforated NECCity Dudley RdBCH PICUIMVOn05.06.1214:0014:1514:30414:45316:2516:452hrs 45minsBaby hypothermic due to need for emergency abdo drain insertion. Very unstable baby. RIP 29/07/2012nothing for August05.09.12Perforated NECHeartlandsBCH PICUIMVOn31.08.1219:2019:2020:25820:45322:4023:103hrs 50mins13.09.12GastroschisisB'ham Women'sBCH NNSUSVIA11:1512:0012:0012:00012:00412:5013:202hrs 5 mins09.10.12?Perforated NECNew CrossBCH PICUIMVOn06.09.1212:1512:1512:401613:301615:0015:303hrs 15mins16.10.12GastroschisisWalsall ManorBCH NNSUSV 0217:1917:0017:0017:002417:451219:2519:502hrs 31minsTeam diverted from Heartlands transfer01.11.12TOFWalsall ManorBCH PICUIMV00:4510:1010:1510:551311:401213:1514:0013hrs 15minsCall not received by NTS until 1010hrs17.11.12GastroschisisB'ham Women'sBCH NNSUSVA00:2501:1001:1002:20002:20403:0003:303hrs 5minsCall received during on call hours, staffcame 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 24minsCall received during on call hours, staffcame in from home (1 hour approximately to travel to workplace from home) 22.11.12?TOF - duodenal atresiaHeartlandsBCH PICUIMV 07:0013:3013:3014:30815:05316:5518:0011hrsBed not available on PICU until 1600hrs24.12.12GastroschisisB'ham Women'sBCH NNSUInc0213:3714:4514:4514:45014:45416:0016:302hrs 55minsWMNTS not contacted immediately02.01.13GastroschisisB'ham Women'sBCH PICUIMV05:0205:4505:4506:40006:45409:0009:203hrs 18minsCall 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 bed07.01.13GastroschisisB'ham Women'sBCH NNSWNP0218:0519:2019:2019:30019:30420:2020:402hrs 35 mins22.01.13Perforated NECShrewsburyLiverpool IMVunknown13:1013:1014:455215:256916:3018:305hrs 20 minsTime recorded from when call received as time baby born not available01.02.13?PerforationB'ham Women'sBCH PICUIMVOn28.01.1312:2512:2512:25012:30415:2515:553hrs 30minsBaby not ready, required intubation and x-ray05.02.13?Perforated NECHeartlandsBCH PICUIMVOn04.01.1304:4004:4005:45806:05308:1008:253hrs 45 minsCall received during on call hours15.02.13GastroschsisNew CrossBCH PICUSIMV12:4813:2013:2013:451614:401616:0016:403hrs 52minsBed not confirmed at time of referral (confirmed at 13:45)20.02.13Intestinal perforationUHNSAlder Hey PICUIMVOn16.02.1316:0016:1016:355418:005519:3020:454hrs 45minsDelay at Alder Hey waiting for baby to go into theatre27.03.13GastroschisisB'ham Women'sBCH NNSUSVIA10:1711:4011:4512:40012:50413:5014:053hrs 48minsDelay due to baby not yet fully admitted to NNU and no discharge paperwork available28.03.13?Intestinal perforationWalsgraveBCH PICUIMVOn 16.03.1315:2015:3015:453016:202617:5518:553hrs 35minsPerforming transfer on behalf of CenTre teamWest Midlands Neonatal Transfer Service

Types of Time Critical TransfersNo CHD not responding to prostaglandin infusion (4) ; No (5) recordedWest Midlands Neonatal Transfer Service

Meeting standards for time critical transfersWMNTS 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)West Midlands Neonatal Transfer Service

Breaking down our dispatch times we meet the standard with a dispatch time of 25 mins for all. If other factors, e.g. oncall, bed availability are taken into account the figure comes down.However while this looks good we are aware that it only takes 5-10 mins for us to walk from our office to our equipment store and load up and leave. Why are we taking so long?

These slides dont include jobs performed by our other local teams and if we are unable to meet the time critical transfer we will ask other teams to help e.g. on Monday our team was engaged with a cardiac baby when a request for a gastrochisis came in . We would be unable to respond within the hour but our local paediatric team, with whom we work closely were free and were able to respond.

You have seen that even if the team are dispatched appropriately it may still take time for WMNTS to arrive and in the light of that we have been very keen not to deskill the units. Working with both of our network educators we support network teaching programmes, which are usually free.Dispatch

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