Antenatal maternal transfers in the east of England: role of a centralised cot bureau

Abstract

There are anecdotal reports of expecting mothers, likely to deliver an infant requiring neonatal intensive care, transferred between hospitals because of lack of local neonatal intensive care capacity. However, there are no data on the scale of this practice. The job of locating an admitting hospital often befalls the clinical staff on busy delivery units, taking them away from direct clinical care. Although this activity does not involve neonatal staff directly, it does raise questions about appropriate management of neonatal intensive care unit (NICU) resources locally especially with the development of neonatal networks. Recognising these issues, the regional neonatal transport service extended the role of the neonatal cot bureau to assist regional delivery units in locating suitable admitting hospitals. Starting in November 2003, and working from 0800 to 2030, the bureau operators asked the referring clinicians standard questions, including reasons for the transfer, the gestational age, as well as complications of pregnancy. The operators then phoned hospitals within and, if necessary, outside of the eastern region to locate one with suitable facilities. Once an admitting unit was identified, its contact details were relayed to the referring clinician for further discussions and transfer to take place. The bureau phoned the referring unit later to confirm if the transfer took place. We would like to share the results of this activity over the calendar year 2004.All 18 hospitals in the region used the service, making 262 transfer requests. Admitting units were identified in 179 (68%) cases; 42% of these units were outside of the region. A mean (range) of 7.6 (1-36) hospitals were contacted before an admitting unit could be located. Mean (range) time to locate the unit was 45 (6-215) minutes. Reasons for transfer request included: both delivery and NICU full locally, 11%; delivery unit full, 1.5%; NICU full, 54%; baby expected to be too premature for local NICU, 26%; other, 7%. Mean (range) gestational age at the time of transfer request was 29.5 (23-40) weeks. A total of 165 women were successfully transferred. These patients were transferred over a mean (range) distance of 66.5 (12-250) miles with mean (range) estimated journey time of 80 (14-300) minutes. Of the 85 women not transferred, no suitable admitting units could be located for 43%, transfer request was withdrawn by the referring unit in 38%, 11% delivered before they could be transferred, and admitting units declined after initial acceptance in 2%. No reason for non-transfer could be ascertained by the bureau in 5% of cases.This service is the only one of its kind in the United Kingdom. Although it does not capture the entire regional antenatal transfer activity, it has been of assistance to clinicians in the front line. These data suggest that maternal transfers take place regularly, often over long distances. Finding a suitable admitting unit is a time consuming task. Lack of local neonatal capacity and expertise is a major underlying cause. Wh...

All the right moves: why in utero transfer is both important for the baby and difficult to achieve and new strategies for change

“…Learning from others: centralised transfer services Following their comprehensive audits of the problem, cot bureaus have been established in some regions of the UK 19,32,43 .…”

“…Centralising the referrals reduces the clinical time spent on organising transfer, establishes a unified process across hospitals, and is likely to create efficiencies due to developing expertise in the problem. However, even within these dedicated services, around one-third of transfer requests are unsuccessful because of capacity issues, withdrawal of requests, or a lack of consensus on the appropriateness of the in utero transfer 20,33,43 . This suggests culture change amongst referrers and receivers of in utero transfers is needed in addition to further investment in capacity.…”

“…Following their comprehensive audits of the problem, cot bureaus have been established in some regions of the UK 19 , 32 , 43 . As well as regularly phoning neonatal units to check cot status, the cot bureaus liaise with neonatal and maternity teams to arrange referrals for particular requests.…”

Effect of a centralised transfer service on characteristics of inter-hospital neonatal transfers

“…7 However, to facilitate appropriate in-utero transfers, systems are needed in which maternity staff can make a single call, as in the Neonatal Transfer Service, with administrative staff then negotiating and confirming both neonatal cots and labour ward placement. 8 A recent London Assembly report has recommended that the most rational way to optimise use of maternity and neonatal resources may be to develop perinatal, rather than purely neonatal, networks. 9 This census has demonstrated the ability of centralised but dedicated neonatal transport services to deliver a substantial improvement in response times for emergency neonatal transfers.…”