Who should staff neonatal transport teams?

doi:10.1016/j.earlhumdev.2009.05.006

Early Human Development

Volume 85, Issue 8, August 2009, Pages 487-490

https://doi.org/10.1016/j.earlhumdev.2009.05.006 Get rights and content

Abstract

Neonatal transport is variously staffed by diverse combinations of nurses, doctors and paramedical staff. There is no evidence that neonatal transport undertaken with staff from any particular professional background results in improved outcomes for infants; instead, it appears that beneficial outcomes result from using staff who are specifically trained in transport practice, regardless of their professional background. Core transport competencies that are transferrable should be a routine part of the training of transport team members.

Introduction

In the United Kingdom (UK) and around the world there are various models used for the staffing of neonatal transfers. These generally include a combination of neonatal nurses, nurse practitioners, paramedics, doctors in postgraduate training program, and post-training doctors. Specific roles have been developed for transport nurses, transport fellows, and respiratory therapists. For some of these groups there is a literature which describes and/or evaluates their introduction into clinical practice [1], [2].

It is now widely accepted that specific transport training is required by staff who will be called upon to transfer neonatal patients. This was not always the case. In the UK in the 1990s it was common for infants to be transferred by staff who worked within the neonatal environment but who had little or no specific preparation for transport. Moreover their individual exposure to neonatal transport was relatively limited. Over the last twenty-five years there has been an accumulation of data which suggest that transports undertaken by staff without specific training results in worse transport outcomes [3], [4], [5]. More recently in the UK there has been a shift to provision of transport services on a regional basis, driven in part by the establishment of managed clinical networks.

A few studies have evaluated different professional groups against each other in the transport setting, where everyone involved has received transport training. Where personnel from different backgrounds are compared it appears that there are no clinically important differences between the groups [6], [7], suggesting that the professional background of transport personnel matters less than the training they have received.

At present there are no widely agreed core skills and knowledge sets for those undertaking neonatal transport in the UK, so the nature, content and objectives of training are determined locally. Anecdotally this ranges from basic operation of transport equipment alone to transport-specific physiology (for example the effects of altitude during air transfer) and the logistics of coordinating the various agencies involved in undertaking a transfer. Whilst there are undoubtedly team-specific arrangements and local protocols which are relevant and important in particular sites which new team members will have to become familiar with, it also seems likely that there are core transport competencies which any program of training should include.

In this paper we discuss the advantages and disadvantages of different models of staffing neonatal transfers and propose an outline of what the contents of a training program for transport should include. The latter is divided into sections concerned with transport models and regional organisation, organising transfers, communication and documentation, neonatal medicine and practical skills, stabilisation prior to transport and working within the transfer environment.

Airborne transport will only be discussed briefly since it is a relatively unusual mode of transfer in the UK and also because it has some very specific training needs.

Section snippets

Staffing issues

The first consideration in staffing a neonatal transfer service is whether the transfer service will be ‘stand alone’ or affiliated to and staffed by a particular neonatal unit. This has important implications for staffing: stand alone teams have the clear advantage over unit-based teams of not taking neonatal unit staff away from the ‘shop floor’ but have the disadvantage of being more costly and potentially less flexible because of the necessarily smaller pool of staff employed. As a result

What should core training for transport include?

This section outlines a proposed set of headings for core competencies for neonatal transport. It is to be emphasised that these skills should be regarded as the minimum sum total of skills available on the transport team — whilst not every doctor needs to know how to complete the observations chart and not every nurse needs to know how to place a chest drain, all of these skills need to be present in the team attending the transfer of a sick infant.

How should transport skills be acquired?

The different groups involved each come with variations in their background and there are differences and commonalities in what each needs to know and how this can be achieved. All groups need to be encouraged to attend multidisciplinary courses covering life support and neonatal transport skills.

Transport nurses are likely to be tenured staff who will be with the transport service for a considerable time. They are also the people who will attend most transfers, as many transfers are

Miscellaneous

By its very nature transport happens in isolation. Problems that occur on transport may have solutions that should be shared among the whole team. A key component of ongoing education for team members is the opportunity to talk about recent transfers and learn from each other. Team structure should allow for regular open transport meetings where this can happen.

All staff involved in neonatal transport should be able to critically appraise their performance and be involved in audit/quality

Key guidelines

•
Neonatal transfers may be performed by a variety of personnel
•
A range of transfer service models exist, depending on local and regional factors
•
Transfer-specific training improves outcome measures for all staffing combinations
•
Transfer training should include specific core competencies.

Conclusion

Providers of neonatal transport services can make choices on the composition of transport teams on the basis of staff supply, transport demand, budget, and other local factors. There is no evidence that choosing one professional group over another will provide a more effective transport service. Instead, it is critical that transport services are planned with training as a central activity, both for new staff joining the service and continuing education for existing staff.

The choices between

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Recommendations on the skills profile and standards of the neonatal transport system in Spain
2021, Anales de Pediatria
Las primeras horas de vida de un recién nacido enfermo o prematuro son cruciales para su pronóstico y, por lo tanto, el parto debería acontecer en un centro preparado para ese grado de complejidad. Cuando no se cumple esta condición, el recién nacido debe ser trasladado de un modo óptimo y seguro al centro que pueda ofrecerle los cuidados necesarios. La formación, la dotación, la organización y la coordinación del equipo de transporte neonatal son indispensables para garantizar un traslado en condiciones. Siendo conscientes del interés y los avances que en la actualidad se están produciendo en esta área de la pediatría, la Comisión de Estándares y la Comisión de Transporte Neonatal de la Sociedad Española de Neonatología han elaborado el presente documento. En él, se ha revisado y detallado de forma exhaustiva tanto la dotación de recursos humanos y materiales necesarios como las bases de la estabilización clínica en transporte para llevar a cabo el traslado neonatal de forma segura y proporcionada a las necesidades del recién nacido crítico.
The first hours of life of a sick or premature newborn are crucial for its prognosis and therefore delivery should take place in a center prepared for that degree of complexity. When this condition is not met, the newborn must be transferred in an optimal and safe way to the center that can offer the necessary care. The training, staffing, organization and coordination of the neonatal transport team are essential to guarantee a safe transfer. Being aware of the interest and the advances that are currently taking place in this area of pediatrics, the Standards Commission and the Neonatal Transport Commission of the Spanish Society of Neonatology have prepared this document. In it, both the provision of human and material resources necessary as well as the bases of clinical stabilization in transport to carry out the neonatal transfer in a safe way and proportionate to the needs of the critical newborn have been exhaustively reviewed and detailed.
Challenges relating to the inter-facility transport of high acuity paediatric cases
2018, African Journal of Emergency Medicine
Citation Excerpt :
“There’s only one B.Tech [ECP] practitioner practising, so I don’t have sufficient contacts” – EMS manager Over the last 30 years, much data has been accumulated that suggests that when personnel that do not have the appropriate level of training undertake a neonatal transfer, poorer outcomes are experienced [13–15]. In many high-income countries, such as the United States of America and the United Kingdom, there are specialist retrieval teams responsible for the transfer of critically ill or injured paediatric and neonatal patients between facilities [13,16].
The motivation for this study came from anecdotal reports and observations that there was a potential need for improvement to the systems that support inter-facility transfers of high acuity paediatric cases between referring and receiving facilities in Johannesburg, South Africa. In this exploratory study, we formally document and describe challenges being experienced by members of the healthcare team in facilitating the inter-facility transport of high acuity paediatric cases.
A qualitative, explorative design was applied, making use of interviews with purposefully-identified role players involved in paediatric transportation and care. Verbatim transcripts from audio recorded interviews underwent content analysis to allow for the identification of common categories.
Participants described a number of challenges, which included time delays, lack of qualified ambulance personnel, poor communication between role players, and lack of appropriate equipment.
There are significant challenges experienced by members of the healthcare team with regard to inter-facility transport of high acuity paediatric and neonatal cases in Johannesburg, South Africa. Whilst we acknowledge the African context and resource constrained setting, health systems managers need to explore the feasibility of establishing dedicated and suitably resourced retrieval teams who specialise in the transfer of high acuity paediatric and neonatal patients in order to improve quality of care and overall patient outcomes in this population.
Does Medical Staffing Influence Perceived Safety? An International Survey on Medical Crew Models in Helicopter Emergency Medical Services
2018, Air Medical Journal
The competence, composition, and number of crewmembers have generally been considered to influence the degree of patient care and safety in helicopter emergency medical services (HEMS), but evidence to support the advantages of one crew concept over another is ambiguous; additionally, the benefit of physicians as crewmembers is still highly debated.
To compare perceived safety in different medical crew models, we surveyed international HEMS medical directors regarding the types of crew compositions their system currently used and their supportive rationales and to evaluate patient and flight safety within their services.
Perceived patient and flight safety is higher when HEMS is staffed with a dual medical crew in the cabin. Tradition and scientific evidence are the most common reasons for the choice of medical crew. Most respondents would rather retain their current crew configuration, but some would prefer to add a physician or supplement the physician with an assistant in the cabin.
Our survey shows a wide variety of medical staffing models in HEMS and indicates that these differences are mainly related to medical competencies and the availability of an assistant in the medical cabin. The responses suggest that differences in medical staffing influence perceived flight and patient safety.
Simulation in neonatal transport medicine
2016, Seminars in Perinatology
Citation Excerpt :
Physicians were initially thought to be essential to the transport of sick patients, especially older children.9 However, several studies have refuted this assumption and demonstrated equivalency, if not superiority, of respiratory therapist-and-nurse or nurse-and-nurse teams compared to doctor-and-nurse teams, in terms of morbidity, procedural competence and efficiency of transports.25,29–31 A recent survey of pediatric transport systems in the US demonstrated that the respiratory therapist-and-nurse combination is most frequently used by providers, although other team combinations continue to be utilized.20,31
The safe transport of infants in critical condition requires highly reliable inter-professional transport teams that are equipped with the expertise to provide neonatal care in unfamiliar and resource-limited environments. Increasingly, transport teams are comprised of health professionals from various disciplines. Providing didactic and experiential learning alone is insufficient to fully prepare teams that have limited exposure to rare events. Simulation-based training supplements and reinforces knowledge, skills, and the experiences of team members. This article presents the current use of simulation in the training of neonatal transport teams and critically reviews how simulation methodologies may be further incorporated into curricula and quality improvement to achieve high-reliability teams.
Utility of a physiologic stability index based on Transport Risk Index of Physiologic Stability (TRIPS) for the evaluation of infants transferred to a specialized hospital
2015, Boletin Medico del Hospital Infantil de Mexico
La mortalidad neonatal es una de las prioridades de la salud pública, por lo que se debe revisar cómo la inestabilidad fisiológica del recién nacido después de un traslado contribuye al incremento de la mortalidad neonatal. El objetivo de este trabajo fue determinar si el índice de estabilidad fisiológica (TRIPS) en los recién nacidos trasladados a la Unidad de Cuidados Intensivos Neonatales de un hospital de segundo nivel sirve como factor predictivo de mortalidad neonatal temprana.
Se valoró el índice de estabilidad fisiológica de la escala de TRIPS para predecir la muerte neonatal en los primeros 7 días del ingreso de los pacientes.
Se encontró que la mortalidad neonatal a los 7 días del ingreso está relacionada con la puntuación de la calificación TRIPS. La puntuación de los sobrevivientes y las defunciones presentaron una diferencia significativa (p = 0.009). Para una puntuación de 16 se determinó una sensibilidad del 62% y una especificidad de 84%, con un área bajo la curva de 0.757.
La ponderación del índice de estabilidad fisiológica de TRIPS es un buen predictor de la mortalidad neonatal. Es importante establecer medidas para mejorar la estabilidad fisiológica de los recién nacidos antes, durante y después del traslado, con la finalidad de disminuir la mortalidad neonatal.
Neonatal mortality is a public health priority. We review the physiological instability of the newborn after a transfer, which contributes to increased neonatal mortality. The objective of this work was to determine whether the Transport Risk Index of Physiologic Stability (TRIPS) in newborns transferred to the Neonatal Intensive Care Unit of a secondary hospital serves as a predictor of early neonatal mortality.
We use the TRIPS to predict neonatal death in the first 7 days after patients’ admission.
Neonatal mortality at 7 days after admission is related to the TRIPS rating. The score of the survivors and neonatal deaths show a significant difference (p: 0.009). For a score of 16, a sensitivity of 62% and a specificity of 84%; area under the curve of 0.757 was determined.
Physiological index weighting using TRIPS is a good predictor of neonatal mortality. It is important to establish measures to improve physiological stability of the newborn before, during and after the transfer in order to reduce neonatal mortality.
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2013, Early Human Development
Citation Excerpt :
It should be run by staff who have the requisite applicable knowledge, practical skill and decision making capabilities to recognise the patient condition both in terms of diagnosis and severity. They should be able to communicate clearly, utilise local help and solve problems well in their attempt to effect stabilisation of the patient [4]. In reverse it is equally important to have a good system in place to facilitate the transfer of these patients back to their hospital of booking.
Interfacility transport is a necessary part of hospital care. Neonates often need to access specialist input at different sites necessitating a reliable transfer process. Services have evolved significantly over the last ten years to meet this need. This followed the recognition that ad hoc arrangements were unreliable and often unsafe.
Services have significantly improved during this time. Attention has been paid to training, clinical governance, disseminating best practice, setting standards, ring fenced funding and supporting parents.
Transport teams have become integral to neonatal network function and quality and performance of transport services needs to be evaluated.
National audit creates useful team comparisons and identifies outlier status allowing closer inspection of variations between services. Work is needed in the form of external appraisal in order to maintain service standards.

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Best Practice Guideline articleWho should staff neonatal transport teams?

Abstract

Introduction

Section snippets

Staffing issues

What should core training for transport include?

How should transport skills be acquired?

Miscellaneous

Key guidelines

Conclusion

Semin Neonatol

J Pediatr

Early Hum Dev

Formation of a neonatal transport team

Paediatr Nurs

Effectiveness of the neonatal transport team

Crit Care Med

Optimal escort for interhospital transport of pediatric emergencies

J. Trauma

Best Practice Guideline article
Who should staff neonatal transport teams?