Background Peri- and postnatal events involving newborns occur 24/7 and to improve the quality of care given to this group of babies on NICUs, there has been calls from, Academy of Royal Medical Colleges, RCPCH, BAPM, government (DoH Neonatal Toolkit) to add on or augment the tier 3 level medical staffing out-of-hours leading to a consultant-delivered type of service. This has also become necessary to help plug the shortage in tier 2 medical staffing as a result of the MMC agenda and EWTD. The provision of this level of service, offers a lot of benefits including rapid appropriate diagnosis, intervention, clinical management decision making, more efficient use of resources, improves parent’s experience and arguably outcomes. From the training viewpoint, the contact time of trainees with consultants is also optimised leading to better supervised training. As a progressive specialty, some NICUs over the last few years, have introduced and incorporated Resident Neonatal Consultant (RNC) roles into their rotas. This is the very first national survey looking at the current use of these group of specialist Aims To determine- number of L3 NICUs that employ RNCs total number employed levels of medical staff cover at night (as a proxy of out-of-hours cover) whether this involves RNCs and at what tier Night medical roles of ANNPs Methods Telephone interview survey L3 NICUs in UK Period Oct –Dec 2013 Results All L3 NICUs were surveyed = 63 Employed in 11/63 (17.5%) of Trust = England 5/42 (12%); Scotland 6/9 (67%); Wales 0/6; NI 0/5 (Figure 1) Total Number employed 48.5 = England 27.5; Scotland 21 Number of night they cover = 2–7 nights/week Number who are used on Tier 2 & 3 rota = 7 & 4 (and dual role in 3) Units with 1, 2, 3 and 4 medical staff at night= 3, 38, 17 and 5 respectively Figure 2) Units using ANNPs on night medical rota = 22/63. Abstract G120(P) Figure 1 No Resident Neonatal Consultants employed in Level 3 NICUs. Abstract G120(P) Figure 2 Night staffing on Level 3 NICUS. Conclusions <1/5 of L3 NICUs in UK are using RNC at both Tier 2 and 3 with a dual purpose of covering middle grade rota (tier 2) and to improve services through consultant-delivered care (tier 3) Scottish NICUs lead the way in the used of RNCs Level of medical staff night cover varies ANNPs play a crucial role in the medical staffing of NICUs

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IntroductionThe Acute Neonatal Transfer Service (ANTS) for the East of England is supported 24/7 by Emergency Bed Service (EBS), whose role in recent years has extended to providing a cot location service for in-utero referrals from the 17 delivery units across the region. The process of locating both an antenatal bed and potential NICU cot is time-consuming involving multiple phone calls to several centres. Short-term outcomes of the process were reviewed.Material and methodsAll in-utero referrals to the EBS from 1/1/2017–30/6/2017 were reviewed using the ANTS database. Demographic details and reasons for referral were identified. The outcome of the process including whether an antenatal transfer occurred, reasons for non-transfer, distance travelled for transfer and whether or not delivery occurred within 7 days was also recorded.Results193 in-utero referrals were made to EBS in the 6 month period, 41, 131 and 21 from Level 1, 2 and 3 units respectively. The 2 most common reasons for referral were a predicted need for a higher level of neonatal care (n=99) and the regional NICU being closed (n=82). 151 of the women underwent antenatal transfer and of these, 51 delivered within 7 days. 112 were transferred to a centre within the East of England, 39 were sent out of region and this necessitated repatriation by ANTS back to the region. Of the 42 women who were not transferred, 8 declined, 29 too unstable to move to the identified receiving unit and in 5, no bed/cot could be found. Amongst those transferred, 75 travelled less than 50 miles while 61 and 15 had to travel more than 50 miles and 100 miles respectively.Conclusions33.7% of infants referred in-utero delivered at the receiving centre within 7 days. 96% of these infants were extremely preterm (<27 weeks). 50% were transferred more than 51 miles away from their primary location needing retrieval by ANTS back to their local units. The emotional and financial impact on these families is yet to be explored. The Operational Delivery network is working on capacity planning to address capacity issues that resulted in 42% of referrals.

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