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Neonatal and Paediatric Critical Care Transfer System Implementation Project (Yorkshire and the Humber)

Neonatal and Paediatric Critical Care Transfer System Implementation Project (Yorkshire and the Humber). Michelle Milner Project Manager. Current service configuration:- Neonatal.

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Neonatal and Paediatric Critical Care Transfer System Implementation Project (Yorkshire and the Humber)

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  1. Neonatal and Paediatric Critical Care Transfer System Implementation Project (Yorkshire and the Humber) Michelle Milner Project Manager

  2. Current service configuration:- Neonatal • NIC services – investment of around £750k but neither service is able to provide a 24 hour service 365 days per year. • Both current services for neonates support nurse led transfers for non acute patients • Both neonatal services reliant on middle grade medical staff for the provision of out of hour and acute neonatal transfers • Both Networks have invested in ANNPs, however, not all acute transfers can be carried out without middle grade support

  3. Current service configuration:- PIC • 2 PIC services in LTHT and SCH • Both are similar with no additional resources to support a separate retrieval service to bed base • Therefore if a bed & staff there will be a transfer – no bed / no staff means that the PIC services can not transfer child

  4. Risks • Impact of EWTD and medical training • Sustainability of current services • DGH risks associated with lengthy wait for transfer and requirement to transfer when a team not available • Unmet need for HD children particularly cardiac and surgical • Current problems with out of hours services for neonatal transfers resulting in secondary care services holding onto babies until transport teams are available • Reconfiguration of services can not occur without a comprehensive transport infrastructure

  5. Background and work so far • Project commenced two years ago to establish a transport service for Yorkshire and the Humber region for children and neonates • Project steering group reports to SCG as project board for the implementation of service • Developed a service specification describing the standards and requirements of the new service • SCG have agreed to support an internal collaborative arrangement with the three current provider organisations to deliver the new service by August 2009

  6. What will the new service look like • One telephone access • Call centre where all calls are able to be recorded and where there is a facility to deliver call conferencing between referring units, receiving units, sub specialty consultants and transport team • Team located centrally between Sheffield and Leeds • Four day time teams to carry out acute transfers, non acute neonatal transfers and back transfers • One night time team for acute transfers with a second on call consultant team if required • Driver crew forming part of the transport team and located with the team • Vehicles separate from the YAS emergency fleet

  7. Who will the new service transfer:- • All neonates requiring transfer between hospital sites (acute and non acute) • Critically ill children requiring both PIC and HD care (regardless of whether there is a bed within the region) • Acute patients requiring specialist out of region services e.g. burns, cardiac and ECMO • Critically ill neonates and children, requiring acute transfer from out of region units, at times of high demand when there is no capacity in their local facility • Cardiology patients requiring out of region for speciality services • PICUs in Leeds and Sheffield for back transfers • Neonates and children requiring repatriation back to a local unit for ongoing management following intensive care

  8. Advice calls:- The transport service will accept calls for advice for the following types of transfer:- • Non critical care inter-hospital transfers of children • Rapid response helicopter / air ambulance emergency transfers between secondary and tertiary care • Time critical patients (head injury, blocked VP shunts etc)

  9. Exclusions:- • Adult transfers • Fixed wing and helicopter transfers • “Primary response” transfers • Inter hospital transfers

  10. Summary of 2006/7 transfers

  11. Summary of all transfers by month

  12. Transfers by time of day

  13. Call centre standards:- • Will log and record all calls • Will take initial details of caller, provide details of available beds to obstetricians and pass on all requests for transfer to either nurse co-ordinator for planned transfers or consultant for acute transfers • Will establish call conferencing with referring unit, accepting unit, consultant for transport and transfer team and any other specialist as appropriate • Will work within patient flow algorithms to determine most appropriate destination of patient • Will audit all transfer requests and details of transfers to provide data on the service activity

  14. Referring Neonatal Unit If no bed Neonatal Other specialist cardiac centre Cardiac (All) Back transfers To nearest unit in geographical distance to home Leeds Neonatal surgical Level 3 tertiary care Movement of babies for intensive care York Harrogate Mid-Yorks Bradford Airedale Calderdale to Leeds Scar-borough to Hull Airedale Calderdale to Bradford Jessops Wing Barnsley Bassetlaw Chesterfield Doncaster Grimsby Rotherham Scunthorpe to Sheffield Children's York Harrogate Pontefract Dewsbury to Leeds Barnsley Bassetlaw Chesterfield Doncaster Grimsby Rotherham Scunthorpe to Sheffield Jessops Wing The movement of babies to meet neonatal standards will be determined by geographical distance from the babies home location to provide care as close to home as possible. Scar-borough to Hull

  15. Referring Unit for PCC Burns requiring ventilation to Manchester or Liverpool all other burns patients to appropriate centre's Transfer out of cardiac patients for specialised services Acute PCC Back transfers from PICU From Leeds or Sheffield to nearest unit in geographical distance to home Bradford Airedale Calderdale Mid-Yorks Northallerton Harrogate York Scarborough Hull to Leeds Barnsley Bassetlaw Chesterfield Doncaster Grimsby Rotherham Scunthorpe to Sheffield Children's Leeds Cardiology to Great Ormond Street Guys Hospital Birmingham Children’s or other external cardiology service for specialist services If P I C U full If both PICUs full transfer to out of region PICU e.g. Nottingham Manchester etc.

  16. Clinical care staff:- 24 hour consultant cover – day time consultant cover and on call night time cover • Consultants with either Neonatology, Paediatric Intensive Care, Anaesthesia or Paediatric Emergency Medicine background • Certified providers of APLS, NLS and PanSTAR, or be prepared to undertake this training. 24 hour middle grade cover • Trainees will be Specialty Training Registrars (StRs) at ST6 or above, who have completed core training. • 8 person rota Nursing:- Permanent / rotational / secondment staff • One lead nurse • Advanced nurse practitioners • Senior transport nurses • Rotational / secondment nurses 4 day time teams of nurses (includes ANP nurses) 2 night time teams of nurses

  17. Vehicle and crew provision • Four vehicles – set up using SCH specification • One / two being charitably donated • YAS contract for provision and servicing of vehicles • Driver crews – a team of drivers located with team (four each day and two each night), blue light trained, non clinical, single driver per vehicle

  18. Where are we now with implementation project Lead provider agreed – SCH Working up a timetable for implementation Three sub groups:- • Clinical care group • Service development group • Vehicle provision group Will develop a Transport Service Management Board

  19. Agree job descriptions Develop process for consultant appointments Develop process for middle grade staffing agreement with Deanery Produce operational guidelines Produce competency training programme Produce documentation for use in service Develop a list of equipment and consumables required Clinical care sub group:-

  20. Service development group:- • Agree implementation timescales • Agree location of team • Agree TUPE requirements for current staff and timescales • Determine call centre location e.g. with team location or sub contracted through YAS call centre • Develop and agree service level agreement with lead provider • Work up service contracts with lead provider

  21. Vehicle provision:- • Agree resource requirements for vehicle and driver provision • Develop timescales for recruitment of drivers • Develop training programme for drivers • Agree timescales for vehicle provision • Develop service level agreement against detailed specification • Agree alterations to current contract arrangements

  22. Any questions??

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