Elsevier

Early Human Development

Volume 89, Issue 11, November 2013, Pages 851-853
Early Human Development

Evaluating and improving neonatal transport services

https://doi.org/10.1016/j.earlhumdev.2013.09.004Get rights and content

Abstract

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.

Introduction

The need to transfer patients either from a pre-hospital to a hospital setting or from one healthcare cbyfacility to another has always been part of providing clinical care [1]. Transporting a patient to the site of definitive treatment where the necessary resources and expertise are located is embedded in the concept of equitable access to necessary healthcare facilities.

Ambulance services provide an excellent primary frontline response for pre-hospital patient transfer throughout the world. Most transport utilises road vehicles but helicopter emergency medical services (HEMS) are also implemented particularly in time critical traumatic emergencies or when road access to the patient is difficult [2].

The United Kingdom (UK) has seen an amazing change in the arena of interhospital transfer for paediatric patients. Centralisation of children healthcare services, the development of paediatric intensive care units (PICU) and cardiac surgical centres for children has been associated with a change from patient retrieval by the specialist centre to a different model of regional retrieval to a number of specialist centres. Transfers are no longer carried out by the receiving hospital staff necessarily but by a dedicated transfer team who may either be hospital based or sited independently of the host trust. This change in practice has developed over time since the late 1990's [3].

A change to neonatal practice in this area started to take place shortly afterwards. Following recommendations from the 2003 Department of Health's ‘National Strategy for Improvement’ networks were formed and continued to evolve with the aim of improving the quality of neonatal care by providing access to resources across a seamless patient pathway involving input and expertise from different centres depending on the infant's needs. This requires improved communication between sites and a concentration of skill where it needs to be leading to a more efficient use of resource availability. Different hospitals within a geographical neonatal network provide different levels of care as agreed by the network and commissioners. As neonatal networks have grown we have seen the development of interhospital guidelines, sharing of best practice and cross pollination of skills and knowledge through rotational working practices.

Neonatal patients have needs that may come as a consequence of prematurity, congenital abnormalities of anatomy or physiology or as a result of unexpected perinatal events. Many of these patients may be subject to a long stay extending to months needing access to intensive care, surgical skill, cardiac expertise etc. Even those with a relatively short stay of days to weeks may need unexpected access to intensive medical, surgical, cardiac or neurological specialist care unavailable at the local hospital. Accessing all these services requires a dedicated, stand alone transfer facility that can respond quickly. 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. This allows them to access the appropriate level of care as their needs step down in terms of intensity. It keeps babies as close to home and their families as possible, fosters links between the family and the local hospital and also keeps specialist cots free for new admissions.

The UK now has over twenty dedicated neonatal transfer services in operation providing rapid response patient stabilisation and transfer services based on regional requirements and supporting the core function of neonatal networks. Operational cross cover arrangements have further served to ensure near total coverage of the United Kingdom with particular growth over the last five years.

Section snippets

Service improvement

The practice of transport medicine has formalised a great deal over the recent years. No longer are unit staff numbers compromised in the event of a transfer as used to be the case. Staff dedicated to transport duties are now usually rostered specifically to the task. In addition it is now no longer the least experienced staff member expected to undertake the transfer of a critically ill baby but more often an individual who has received specific training and who has already been chosen to be

Evaluating services

The formalisation of transfer services into dedicated teams, the development of training programmes and national service specifications means that neonatal transport teams now require enhanced evaluation and assessment processes. Designing complex and detailed service standards is meaningless without having the tools to measure a service against them. Although most teams will have mechanisms of internal quality control there is now a clear need for external quality control to ensure that

Conclusion

The last ten years has seen an enormous change in the neonatal transport process from ad hoc movement of patients by relatively untrained hospital based staff to commissioned regional services responsible for receiving referrals, giving advice, effecting stabilisation and moving the patient in a seamless and professional manner.

Formal training has improved significantly with simulation taking a prominent position in this and case reflection becoming part of daily activity. In addition a

Key guidelines

  • Implementation of competency assessment as routine practice within teams.

  • Conducting case reviews on a fixed, regular basis.

  • Contribute team data to national benchmarking processes.

  • Strive towards achieving national service specifications.

  • Introduce external appraisal of transport services.

Research directions

Although it would be a challenge, conducting an assessment of mortality rates in infants undergoing interhospital transfer over time since EPICURE 2006 may indicate the possible impact of trained teams in the UK.

Conflict of interest statement

None to declare.

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