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BAPM & NTG NEONATAL TRANSFER DATASET 2016
Purpose of BAPM & NTG dataset

Standardise transport service data collection to be congruent with current national
neonatal service requirements

Improve service quality and responsiveness of the UK Neonatal Transfer Teams

Standardise Data for benchmarking between Transfer services

Define group of Time Critical Transfers for standardised reporting

Define Standards for Transfer Team Despatch

Standardise terminology for whole transfer process
Notes
a.
All airborne transfers are excluded
b.
This classification system doesn’t preclude transfer services from classifying their own transfers
in any way necessary for local data reporting.
Section 1. Classification of Transfers1
Each transfer will be classified by using the grids below according to the BAPM category of care, the
clinical reason for transfer, the operational reason for transfer and the urgency for transfer. Classification
based on intention at time of team departure. Choose one category from each of sections 1.1, 1.2, 1.3
and 1.4
1.1 BAPM Category of Care2
Intensive Care
High Dependency Care
Special Care
Scope: All transfers.
Notes: Transitional care / normal care not included as basic monitoring used for all babies in transfer
1.2 Primary Clinical reason for transfer
Medical
Surgical
Any surgical speciality
other than cardiac or
neurological.
Include transfers for
surgical review, even if
surgery is not
scheduled.
Scope: All transfers.
Cardiac
Known or suspected
cardiac abnormality
Rhythm disorder
Neurological
HIE
Therapeutic hypothermia
Seizures
Neuromuscular
Intra-Cranial Haemorrhage
PDA
Notes:
Categorise on the intended treatment the infant will receive on completion of transfer eg if an
infant went to a cardiac surgical centre, received a procedure and is transferred back to the NICU 2
days later, the infant is a cardiac transfer on the outward leg and a medical transfer on the return leg.
Infant going to surgical centre for review of abdominal distension but improves without surgery is a
surgical transfer.
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2
The NTG dataset is for inter-hospital transfers only. Intra-hospital transfers are not included.
BAPM categories of care 2011
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1.3 Primary Operational Reason for Transfer
Uplift
Transfer for care that
the referring centre
does not normally offer
Resources / Capacity
Capacity (cot spaces)
Repatriation
Transfer to a centre
closer to home
Staffing
‘Step down’ care
Out patients
Includes:
Cardiac ECHO
EEG
MRI
Day care surgery
Scope: All transfers.
Notes:
a. “Resources / Capacity” should be applied to situations where the primary reason for the transfer is
that the referring unit are unable to keep to infant for care, which they would normally be able to offer,
because they are short of space, staff or other resources.
b. “Repatriation” is return to a unit closer to home.
c. Where the referring centre wants repatriation to home unit expedited for capacity reasons the
transfer should these be classified as Resources / Capacity
d. Elective transfers for surgery or other reason should be separately identifiable within the uplift
category, so they can be included or excluded in data comparison exercises (e.g. transfer for PDA
ligation).
1.4 Timescale transfer required
Within 1 hour
Within 24 hours
Scope: All transfers.
>24 hours
Notes:
a. Use intention to treat throughout. Within what timescale did you set-out to arrange this
transfer? i.e. NOT the timescale in which it actually happened. If a “within 1 hour” response was
deemed necessary and attempted, but the despatch took longer for any reason, it should still be
classified as “within 1 hour”.
b. IMPORTANT: note that the “within 1 hour” category here is for service and NTG use. See Section
1.5 for guidance regarding recording and reporting against the “time-critical” 60 minute despatch time
standard.
Examples:
 Ventilated 27/40 born in LNU transferred to NICU = ‘Intensive care / medical / uplift / <24hrs’
 Stable 28/40 off respiratory and other IC support moved urgently to create capacity for new
admission in NICU
=
SC / medical / resource / 1hour
 26/40 returning from NICU to LNU after NEC surgery, on TPN = HDU / medical / repatriation /
>24hrs
 Referral of baby from LNU to NICU for insertion of broviac = HDU / surgical / uplift / <24hrs
1.5 Time Critical Transfers
“For Emergency (unplanned) transfers which are deemed time critical, the transfer team
departs from base within one hour from the start of the referring call.”


An initial proposed group of Transfers is defined for classification as Time Critical for the purpose
of measuring this CQUIN data point.
The inclusion criteria detailed below are intended to be used for like-with-like benchmarking
between transfer services. It is recognised that in the clinical setting, transfer teams may also
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


develop their own criteria for which transfers require a time-critical response which match local
needs. These local time-critical transfers are not included in team-to-team benchmarking.
This is not an exhaustive list, but one which seeks to remove ambiguity.
Further future dataset modifications may include a longer list of agreed Time Critical transfers.
All transfers will be for Uplift in classification 1.3 above
1.6 Clinical criteria for Time Critical Transfers:
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 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)
1.7 Counting two-way transfers.
Each journey undertaken by an infant is counted as a separate transfer.
Where an infant is taken from a NICU to another hospital for a scan or for surgery or for any
other procedure and who is then returned to the original unit or moved to another hospital this
counts as two transfers. Each transfer, the outward and the return, is a separate data item for
database and reporting purposes. This applies equally when the same team stays with the
infant to undertake both transfers and when two different teams are used for the two legs of
the journey.
For time-recording purposes the first transfer lasts from referral until the
investigation/procedure is completed and there is an intention to proceed to the second
transfer. The second transfer thus starts after the procedure when the decision has been
confirmed to proceed with the second transfer.
For categorisation purposes, each leg of the infant transfer is classified individually. For
example where an infant is taken from referring unit to a cardiac centre for an echo and then
returned to the referring unit, the outbound transfer will be “cardiac/uplift” and the return a
“medical/repatriation.”
Section 2. Time Standards
Scope: Record for all transfers classified in 1.3 above as needing transfer for “Uplift” or “Resources /
Capacity”
Dual data collection will be performed for despatch time according to Transfer Team location at time
of referral
1. For ALL Time Critical Transfers (Standard Despatch Time)
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2.
For Time Critical Transfers when the team are at their base at the time the call is received
(Despatch Team at Base)
2.1 STANDARD DESPATCH TIME = 60 minutes for Time Critical transfers
Defining the time-points
 Clock starts when the referral call is answered by the transfer service or emergency bed service
 Clock stops when the transfer team is departing from their location (base or from previous
transfer)
Note: “Advice calls” are not included. If at the time of the call the team who are with the patient are
seeking advice on management but NOT transfer, the clock has not started. If the team who are with
the patient are calling for advice AND to refer for transfer, the clock is started from the beginning of
the call.
The data includes ALL transfers, i.e. when team at base and when on transfer
Note: For reporting for inter-service benchmarking for this standard ONLY transfers from the
categories listed in section 1.6 should be included (It is acknowledged that services may develop
local extra categories, but these should be filtered-out for national reporting).
2.2 DESPATCH TEAM at BASE
Teams will also collect data for benchmarking purposes for Time Critical transfers when team at base
at the start of the referral pathway.
In future this data may be used to agree a separate time standard eg 30 minutes despatch time for
Time Critical Transfers when team at base
2.3 STABILISATION TIME
Teams will also collect data for benchmarking purposes for stabilisation time for Time Critical
Transfers.
Defining the time-points for stabilisation time:

Clock starts when the transfer team arrive on the neonatal unit of the referring hospital

Clock stops when the transfer team depart the neonatal unit of the referring hospital
Note:
Transfers that are aborted before mobilisation are excluded from data collection
Section 3. Support & Treatment in Transit
Data items
Ventilated
HFOV
CPAP
High-flow
iNO
Inotrope support
Prostin
Therapeutic Hypothermia
Parent
None of the above
Scope: All Transfers
Notes:
a. Record all data items that apply
b. Record the support if it was delivered while the infant was in transit i.e. do not include data items where
that support was stopped before the actual transfer. Include support started during the journey
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Ventilated
Ventilated (any mode) via an endotracheal tube or LMA while infant in transit
HFOV
High-frequency oscillatory ventilation delivered by any device while infant in transit.
CPAP
CPAP delivered by any device while infant in transit
High-flow
High-flow therapy delivered by any device while infant in transit
iNO
Use of inhaled nitric oxide at any point during transfer
Inotropic support
Intravenous infusion of any pressor agent
Prostin
Intravenous infusion of any i.v. prostaglandin
Therapeutic Hypothermia
- With the intention of inducing hypothermia for neuroprotection. Primary transfer only.
- Do not include occasions where the team attended the infant but transfer did not proceed.
- Record whether passive or active cooling was utilised with the infant in transit.
- Record the age of the infant (hrs:mins) when hypothermia target temperature (33-340C) was achieved
for the first time. Record for all transfers for hypothermia, including where this time precedes the arrival of
the transport team with the infant.
Parent
Parent / parent representative transferred with infant
Section 4. Infant Details
Scope: Record for all transfers classified in 1.3 as needing transfer for “Uplift”
Category
4.1 Infant details
Data items
Notes
Birthweight
Gestation at birth
DoB
Date of transfer
When the transfer team first
assess the patient
When stabilisation
complete but before
transferring
On completion of transfer
Enter number for
each
4.3 pCO2
When the transfer team first
assess the patient
When stabilisation
complete but before
transferring
On completion of transfer
Enter number for
each
4.4 Temperature
When the transfer team first
assess the patient
When stabilisation
complete but before
Enter number for
each
4.2 pH
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Enter number for
each
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transferring
On completion of transfer
4.5 Collection site of blood
gas data
Arterial
Capillary
Venous
Tick one, for each
gas data point
Definitions
It is not necessary to collect any data which is not clinically indicated
4.1: Infant details
Birthweight
Four digit number representing birthweight in grams.
Gestation at birth
The best estimate of gestational age at the time of delivery in completed weeks. This will normally be
based on the postmenstrual age, but may be modified on the basis of antenatal ultrasound scan. Where
the gestational age at delivery is unknown, this is based on postnatal estimate of maturity.
Two digit number, of completed weeks.
DoB
dd/mm/yy
Date of transfer
dd/mm/yy
If the transfer runs from one day into the next, record the date on which the team departed from the base
hospital
4.2: pH
Up to three digit number with decimal point between the first and second digits.
4.3: pCO2
In kPa. Up to three digit number with decimal point between the first and second digits.
.
4.4: Temperature
In degrees centigrade. Axillary temperature is recommended, except cooling where rectal is the preferred
route. Three digit number with a decimal point between second and third digits.
4.5: Collection site of blood gas data
Scope: Wherever blood gas data are collected
With each blood gas data point indicate if the sample was arterial, capillary or venous.
Time Points
When the transport team first assess the patient
Values obtained on the team’s initial assessment of the condition of the baby. The measurement does not
have to have been obtained by the transfer team; if the transfer team are able to commence stabilisation
management using values obtained before their arrival by the local team, then these values should be
recorded.
When stabilisation complete but before transferring
If the condition of the infant requires that further values are obtained during stabilisation then the last pretransfer value should be recorded. Leave blank if no further values obtained.
On completion of transport
Values obtained on arrival at the receiving unit whilst the infant is still within the transport incubator.
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Section 5. Standardised Terminology for Neonatal Transfer process
At all times using 24 hour clock
Referral time = time referral 1st made (phone answered)
Standard Despatch time = time from referral to mobilisation from team base or previous transfer
Despatch when Team at base = time from referral to mobilisation from team base when team at base at
referral
Transit 1 = from mobilisation to arrival referring unit
Response time = from referral to arrival referring unit
Stabilisation time = time in referring unit
Transit 2 = from departing referring unit to arrival receiving unit
Retrieval time = 1st referral to arrival receiving unit
Total mission time = 1st referral to return to base or start of next transfer if back-to-back
Additional definitions: some teams record other stages in the transfer process eg:
Decision time = time from referral to referral accepted
Activation time = time from Decision to mobilisation from team base
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