Neonatal Transport Group
Neonatal Transport Dataset
Leeds, November 2012
Background
• Interim year between old
“planned/unplanned” model and new
version of dataset.
• Next year’s returns based around new
dataset.
• For this year only mostly just simple
activity data.
What’s different?
• Planned/unplanned has gone.
• Replaced by a 4-level categorisation
– BAPM category of care (3 categories)
– Primary clinical reason for transfer (4)
– Primary operational reason for transfer (4)
– Timescale transfer required (3)
• EVERY inter-hospital neonatal transfer
categorised against these categories.
Categories
Replaced by a 4-level categorisation
Intensive Care
High Dependency Care
Special Care
Medical
Surgical
Cardiac
Neurological
Uplift
Resources/
Capacity
Repatriation
Outpatients
Within 1 hour
Within 24 hours
>24 hours
• EVERY inter-hospital neonatal transfer
categorised against these categories.
Time
Time is confusing!
There are two separate but related time
categories.
1. EVERY transfer is categorised against this:
Within 1 hour
Within 24 hours >24 hours
…where you should use the “within 1 hour” category for ANY transfer where you
set-out to be mobile within 1 hour of receiving the call.
2. A subset of “within 1 hour” transfers that meet the
time critical criteria should be flagged separately
for national benchmarking of response to timecritical transfers.
2012 Data Returns
Method
• Email to transport service’s medical and
nursing leads in Sept 2012
• Requesting activity data from 1.1.12 to
31.6.12
• Brief additional information about each
service.
UK summary data, 1.1.12 – 31.6.12
Total transfers
7152
Ventilated
1889 (26%)
CPAP
847 (12%)
No resp support
3694 (52%)
Cooling
247 (3%)
iNO
99 (1%)
On inotropes
420 (6%)
UK summary data, 1.1.12 – 31.6.12
Total for UK
median(range)/team
Palliative care (20 teams)
22
0 (0-3)
PDA (19 teams)
91
2 (0-33)
OPA
417
8 (0-141)
Awayday treatment
179
6 (0-40)
321
1 (0-253
(21 teams)
Paediatric transfers
(20 teams)
Service Characteristics
No
Yes
25
20
15
10
5
0
24hrs
Dedicated
vehicles
Cot bureau
Conf. calls
N.
Sc
W ot
Sc
SE ot
Sc
ot
N
Ire
la
Cu n d
m
Ne b ri
wc a
as
t
M le
er
s
G ey
M
M
id
Ne
dl
es Ts
br
o
Em ugh
br
ac
Ce e
nT
re
W
.M
id
s
AN
TS
C
S
ha
C
en nts
tra
l(
N
Br )
ist
o
Lo l
nd
on
Ke
Su nt
ss
ex
Su
rr e
y
So
Pe len
ni t
ns
ul
a
Total Transfers/team
800
700
600
500
400
300
200
100
0
.S
c
W ot
S
SE cot
S
N co
Ire t
C land
u
N mb
ew ria
ca
s
M tl e
er
M GM sey
id
dl Ne
es T
br s
Em oug
br h
a
C ce
en
W T re
.M
id
AN s
T
S Ch S
C
en ant
tra s
l(
N
Br )
is
Lo tol
nd
on
Ke
Su nt
ss
e
Su x
rre
S y
Pe ol e
ni nt
ns
ul
a
N
Number of ventilated transfers
350
300
250
200
150
100
50
0
N.
Sc
W ot
S
SE cot
S
N cot
Ire
la
Cu n d
m
Ne b r
wc ia
as
t
M le
er
se
G
y
M
M
id
N
dl
es e Ts
br
o
Em ugh
br
ac
Ce e
n
W Tre
.M
id
s
AN
TS
S Ch
a
C
en nts
tra
l(
N
Br )
ist
Lo ol
nd
on
Ke
Su nt
ss
ex
Su
rr e
So y
Pe len
ni t
ns
ul
a
% of all transfers on a ventilator
60%
50%
40%
30%
20%
10%
0%
N.
Sc
W ot
S
SE cot
Sc
ot
N
Ire
la
Cu n d
m
Ne b r
wc ia
as
t
M le
er
se
G
M
M y
id
dl Ne T
es
br s
o
Em ugh
br
ac
Ce e
n
W Tre
.M
id
s
AN
TS
C
S
ha
C
en nts
tra
l(
N
Br )
ist
Lo ol
nd
on
Ke
Su nt
ss
ex
Su
rr e
So y
Pe len
ni t
ns
ul
a
Average number ventilated
transfers/week
14
12
10
8
6
4
2
0
.S
c
W ot
S
SE cot
S
N cot
Ire
C land
um
N
ew bria
ca
st
M le
er
se
G
M
id MN y
dl
es eT
br s
o
Em u g
br h
a
C ce
en
T
W re
.M
id
AN s
T
S Ch S
C
en ant
tra s
l(
N
Br )
is
Lo tol
nd
on
Ke
Su nt
ss
e
Su x
rre
So y
Pe l e
ni nt
ns
ul
a
N
Number on CPAP/high-flow
120
100
80
60
40
20
0
N.
Sc
W ot
Sc
SE ot
S
N cot
Ire
la
Cu n d
m
Ne b r
wc ia
as
t
M le
er
se
G
y
M
M
id
N
dl
es e Ts
br
o
Em ugh
br
ac
Ce e
n
W Tre
.M
id
s
AN
TS
C
S
C h an
en
t
tra s
l(
N
Br )
ist
o
Lo l
nd
on
Ke
Su nt
ss
ex
Su
rr e
y
So
Pe len
ni t
ns
ul
a
% of all transfers CPAP,high-flow
25
20
15
10
5
0
Number receiving no respiratory
support
600
500
400
300
200
100
0
t
t
a
e
S nts (N ) tol
re ds
ot cot cot an d b ria stle sey e Ts ugh
on en sex rr ey len
c
T
ul
T
c
i
d
s
a
l
s
i
n
a
l
r
N
r
a
K
S
n
o
r
o
S
s
S
M
N br
n
a
e
b
A
re u m wc
B
S
Su
ni
Ce W.
Ch ntr
M GM
Lo
m
N.
W SE N I
Su
s
e
C
e
E
e
e
P
N
dl
C
id
S
M
t
t
Sc
o
N
Ire t
la
n
C
um d
N bri
ew a
ca
st
M le
er
se
G
y
M
M
id
N
dl
es eT s
br
o
E m ugh
br
ac
C e
en
T
W re
.M
id
s
AN
TS
C
S
ha
C
en nt s
tra
l(
N
Br )
is
t
Lo ol
nd
on
Ke
Su nt
ss
e
Su x
rre
y
So
Pe len
ni t
ns
ul
a
SE
co
Sc
o
.S
W
N
% of all transfers receiving no
respiratory support
80
70
60
50
40
30
20
10
0
.S
c
W ot
S
SE cot
S
N co
Ire t
C land
u
N mb
ew ria
ca
s
M tl e
er
M GM sey
id
dl Ne
es T
br s
Em oug
br h
a
C ce
en
W T re
.M
id
AN s
T
S Ch S
C
en ant
tra s
l(
N
Br )
is
Lo tol
nd
on
Ke
Su nt
ss
e
Su x
rre
So y
Pe l e
ni nt
ns
ul
a
N
Number transferred for cooling or
assessment for cooling
40
From 0% to 6% of
total workload
35
30
25
20
15
10
5
0
.S
c
W ot
S
SE cot
S
N co
Ire t
C lan
um d
N br
ew ia
ca
s
M tle
er
se
G
M
y
M
id
dl Ne
es T
br s
o
E m ug
h
br
a
C ce
en
W Tre
.M
id
AN s
T
S Ch S
C
en ant
tra s
l(
N
Br )
is
Lo tol
nd
on
Ke
Su nt
ss
e
Su x
rre
So y
Pe le
ni nt
ns
ul
a
N
Number transferred on iNO
30
25
20
15
10
5
0
N.
Sc
W ot
Sc
SE ot
Sc
ot
N
Ire
la
Cu n d
m
Ne b r
wc ia
as
t
M le
er
se
M GM y
id
dl Ne T
es
br s
o
Em ugh
br
ac
Ce e
n
W Tre
.M
id
s
AN
TS
C
S
ha
C
en nts
tra
l(
N
Br )
ist
o
Lo l
nd
on
Ke
Su nt
ss
ex
Su
rr e
y
So
Pe len
ni t
ns
ul
a
% of ventilated transfers
transferred on iNO
16
14
12
10
8
6
4
2
0
.S
W
co
t
Sc
SE ot
Sc
o
N
Ire t
la
C nd
um
b
N
ew ria
ca
st
l
M e
er
se
G
M
M y
id
dl NeT
es
br s
o
Em ugh
br
ac
C e
en
T
W re
.M
id
s
AN
TS
S Cha
C
en nts
tra
l(
N
Br )
is
to
Lo l
nd
on
Ke
Su nt
ss
ex
Su
rre
y
So
Pe l en
ni t
ns
ul
a
N
Number on inotropes
80
70
60
50
40
30
20
10
0
.S
co
t
Sc
S E ot
S
N cot
Ire
l
C and
um
N br
ew ia
ca
st
M le
er
se
G
M
y
M
id
N
dl
es eT s
br
o
E m ugh
br
ac
C e
en
T
W re
.M
id
s
AN
TS
S Ch
a
C
en nt s
tra
l(
N
Br )
is
t
Lo ol
nd
on
Ke
Su nt
ss
e
Su x
rre
So y
Pe len
ni t
ns
ul
a
W
N
% of ventilated transfers on
inotropes
40
35
30
25
20
15
10
5
0
Data
• Interim year so quantity, not quality,
oriented.
• Data belongs to the group.
– Send-out to service leads.
– Many projects are possible, following leads in
the data.
Most important service
achievement
• Themes
– Staffing
– Ambulances
– Parents
– Money
– Equipment
Staffing
•
•
•
•
•
•
•
•
•
Keeping a 24/7 service despite unfilled posts
Recruitment of nursing staff and improved availability
Progressive ANNP development – will shortly have 7 WTE dedicated
neonatal transport ANNPs (GMNeTS)
ANNP-led transfers
Supernumary clinical staff – Specialist Trainee x 2 deanery posts plus
dedicated ANNP Weekend cover (Mersey)
Keeping the service going in the face of regular shortages in middle grade
medical staff
More secure medical staff OOH rota.
Continuing to provide the high standard of service we do with the current
service model utilised. We do not have a supernumerary, stand-alone
transport service. It is currently staffed from within exiting nursing
establishment. Additionally despite often having a registrar available during
the day, gaps in the medical rota also makes this difficult.
24 hour service
Ambulances
• Air capability - fixed wing to move all levels
of patients and helicopter to get staff to
patients (Embrace)
• New ambulances approved (London)
• New clamps on incubators, allowing
incubator to be fitted securely in dedicated
neonatal ambulance and in some of the
new front line ambulances (N Scot)
Parents
• Taking Parents on Transfers for all transfers –
(ANTS, Bristol)
Money
•
Completing a year of 24 hours service and
only going marginally over budget.
Equipment
• Purchase of a tecotherm for transport to
facilitate active cooling.
Mysterious…
• “Good start to our first”
Single biggest challenge
• Themes
– Staffing
– Ambulances
– Logistics
Staffing
•
•
•
•
•
•
•
•
Problems with the number of middle grade medical
staff.
More secure medical staff OOH rota.
Keeping the service going in the face of regular
shortages in middle grade medical staff.
covering unforseen sickness and asence.
the threat by London Ambulance Service to pull the
paramedics from our service
employing more experienced ANNP’s
Every adverse staffing challenge to our nursing tier
Finding appropriate cover for all nursing, medical and
driver shifts.
Ambulances
•
•
•
•
•
Re-procurement of ambulance provider.
Safe means of securing incubator into
ambulance following an air transport by
Kingair.
Ambulance provision.
Recruitment of regular Ambulance crew
Only one ambulance between the two
teams
Logistics
• Over-runs.
• Response times.
• Continuing to provide the transport service we
do with the current service model utilised.
• Dovetailing with local paediatric retrieval team
making sure that transfers are performed by
appropriate team - each team liasing with the
other when there are difficulties in performing all
the transfers requested
The future…
• It’s a major first to have data back from
every team.
• The serious work starts next year, with the
new dataset and meaningfully
comparable, quality-oriented data
comparisons.
Ke
n
Su t
ss
ex
Su
rr e
y
So
l
Pe ent
nin
su
la
N.
Sc
ot
W
Sc
ot
SE
Sc
ot
N
Ire
lan
d
Cu
mb
ria
Ne
wc
as
t le
M
er
se
GM y
M
idd Ne T
les
s
br
ou
Em gh
br
ac
e
Ce
nT
re
W
.M
ids
AN
TS
Ch
S
an
Ce
ts
nt
ra
l(
N)
Br
ist
o
Lo l
nd
on
Number transferred for palliative
care
3.5
3
2.5
2
1.5
1
0.5
0
N.
Sc
ot
W
Sc
SE ot
Sc
ot
N
Ire
la
nd
Cu
m
Ne b ria
wc
as
tl
M e
er
se
y
G
M
M
Ne
id
dl
Ts
es
br
ou
Em gh
br
ac
e
Ce
nT
re
W
.M
id
s
AN
TS
Ch
S
a
C
en nts
tra
l(
N
)
Br
ist
o
Lo l
nd
on
Ke
n
Su t
ss
ex
Su
rr e
y
So
Pe lent
ni
ns
ul
a
Number transferred for PDA
ligation
35
30
25
20
15
10
5
0
N.
Sc
o
W t
Sc
SE ot
Sc
ot
N
Ire
la
Cu n d
m
Ne b ria
wc
as
tl
M e
er
s
G ey
M
M
Ne
id
dl
es Ts
br
ou
Em gh
br
ac
e
Ce
nT
re
W
.M
id
s
AN
TS
Ch
S
a
C
en nts
tra
l(
N
)
Br
ist
o
Lo l
nd
on
Ke
n
Su t
ss
ex
Su
rr e
y
So
Pe lent
ni
ns
ul
a
Number transferred for OPA/waitand-return
160
140
120
100
80
60
40
20
0
.S
c
W ot
S
SE co
t
Sc
N
Ire ot
C lan
u
d
N mb
ew ria
ca
s
M tle
er
M GM sey
id
dl Ne
es T
br s
o
E m ug
br h
a
C ce
en
W Tre
.M
id
AN s
T
S Ch S
C
en ant
tra s
l(
N
Br )
is
Lo tol
nd
on
Ke
Su nt
ss
e
Su x
rre
So y
Pe le
ni nt
ns
ul
a
N
Number transferred for day-case
procedure (not incl. PDA)
45
40
35
30
25
20
15
10
5
0
N.
Sc
o
W t
Sc
SE ot
Sc
ot
N
Ire
la
n
Cu d
m
Ne b ri
wc a
as
tl
M e
er
s
G ey
M
M
Ne
id
dl
es Ts
br
ou
Em gh
br
ac
e
Ce
nT
re
W
.M
id
s
AN
TS
Ch
S
a
C
en nts
tra
l(
N
)
Br
ist
o
Lo l
nd
on
Ke
n
Su t
ss
ex
Su
rr e
y
So
Pe lent
ni
ns
ul
a
Number of non-neonatal transfers
300
250
200
150
100
50
0