ࡱ> y Abjbj 3{{:9; 8RFoooooooo$sq%t6o6o4Ko!!!|o!o!!f l -Th:nao0ohtttltl !6o6o!ot : 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 All airborne transfers are excluded This classification system doesnt preclude transfer services from classifying their own transfers in any way necessary for local data reporting. Section 1. Classification of Transfers 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 Care Intensive CareHigh Dependency CareSpecial CareScope: 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 MedicalSurgicalCardiacNeurologicalAny surgical speciality other than cardiac or neurological. Include transfers for surgical review, even if surgery is not scheduled. Known or suspected cardiac abnormality Rhythm disorder PDAHIE Therapeutic hypothermia Seizures Neuromuscular Intra-Cranial Haemorrhage Scope: All transfers. 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. 1.3 Primary Operational Reason for Transfer UpliftResources / CapacityRepatriationOut patientsTransfer for care that the referring centre does not normally offer Day care surgery Capacity (cot spaces) Staffing Transfer to a centre closer to home Step down careIncludes: Cardiac ECHO EEG MRI  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 hourWithin 24 hours>24 hoursScope: All transfers. 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 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: Gastroschisis Ventilated infant with Tracheo-oesophageal fistula +/- atresia Intestinal perforation Suspected duct-dependent cardiac lesion not responding to prostin Unstable respiratory or cardiovascular failure not responding to appropriate management: Despite giving appropriate ventilation via endotracheal tube the infants 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 For ALL Time Critical Transfers (Standard Despatch Time) For Time Critical Transfers when the team are at their base at the time the call is received (Despatch Team at Base) 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). 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 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 itemsVentilatedHFOVCPAP High-flow iNOInotrope supportProstinTherapeutic HypothermiaParentNone of the aboveScope: 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 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 CategoryData itemsNotes 4.1 Infant detailsBirthweight Gestation at birth DoB Date of transferEnter number for each4.2 pHWhen the transfer team first assess the patientEnter number for eachWhen stabilisation complete but before transferringOn completion of transfer4.3 pCO2 When the transfer team first assess the patientEnter number for eachWhen stabilisation complete but before transferringOn completion of transfer4.4 TemperatureWhen the transfer team first assess the patientEnter number for eachWhen stabilisation complete but before transferringOn completion of transfer4.5 Collection site of blood gas data Arterial Capillary VenousTick 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 teams 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 pre-transfer 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. 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  The NTG dataset is for inter-hospital transfers only. Intra-hospital transfers are not included.  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A:                         HW H+eTn\F}m!(#$q@$]m(y(#)DF)}$,.'Emm-t7$G O9]rJkcjIq5HOC+d#6:9<9@""""9p@UnknownG*Ax Times New Roman5Symbol3. *Cx Arial?= *Cx Courier New7.@ Calibri5. .[`)Tahoma;WingdingsA$BCambria Math qhU<'[Ega0g0g2499\ 3QP22!xx "Neonatal Transport Minimum Dataset Alan Fentonviewgit                     Oh+'0|  8 D P\dlt$Neonatal Transport Minimum Dataset Alan Fenton Normal.dotmviewgi6Microsoft Office Word@ @;@0՜.+,D՜.+,T hp  NCHTg9 #Neonatal Transport Minimum Dataset TitleHDl_AdHocReviewCycleID_NewReviewCycle_EmailSubject _AuthorEmail_AuthorEmailDisplayName_ReviewingToolsShownOnce42012 BAPM & NTG updated Neonatal Transfer dataset kate.farrer@addenbrookes.nhs.ukFarrer, Kate  !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnoprstuvwxyz{}~Root Entry F-Data q1Table|)uWordDocument3SummaryInformation(DocumentSummaryInformation8CompObjr  F Microsoft Word 97-2003 Document MSWordDocWord.Document.89qRoot Entry FgL Data q1Table|)uWordDocument3 _AdHocReviewCycleID_NewReviewCycle_EmailSubject _AuthorEmail_AuthorEmailDisplayName_ReviewingToolsShownOnceSummaryInformation(DocumentSummaryInformation8,CompObjr  F Microsoft Word 97-2003 Document MSWordDocWord.Document.89q՜.+,D՜.+,T hp  NCHTg9 #Neonatal Transport Minimum Dataset Title