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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 Transfers[1]
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[2]
Intensive Care / High Dependency Care / Special 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
Medical / Surgical / Cardiac / NeurologicalAny 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
PDA / HIE
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
Uplift / Resources / Capacity / Repatriation / Out 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’ care / Includes:
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 hour / Within 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:
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)
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 itemsVentilated
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
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 / Data items / Notes4.1 Infant details / Birthweight
Gestation at birth
DoB
Date of transfer / Enter number for each
4.2 pH / When the transfer team first assess the patient / Enter number for each
When stabilisation complete but before transferring
On completion of transfer
4.3 pCO2 / When the transfer team first assess the patient / Enter number for each
When stabilisation complete but before transferring
On completion of transfer
4.4 Temperature / When the transfer team first assess the patient / Enter number for each
When stabilisation complete but before 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 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
2012 BAPM & NTG Dataset 2016
[1] The NTG dataset is for inter-hospital transfers only. Intra-hospital transfers are not included.
[2] BAPM categories of care 2011