G211(P) Transferring them out whilst they are still in: the experience of the emergency bed service working with the neonatal transport team

Abstract

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.