Pan-London In Utero Transfer Guideline

Tim Watts

Consultant Neonatologist Evelina London

South London Joint Neonatal Clinical Lead

Improving outcome after extreme preterm birth in the London – still more to do • Variation between 3 networks suggests further improvement possible

• Awareness of importance of optimal place of birth <27 weeks

• Some non-adherence to national service specifications

• Capacity issues

• Need improvement in IUT process

What is so hard about getting women to deliver preterm babies in NICU centres?

• Many women with threatened preterm labour do not deliver, but they may clog up the system

• Maternity capacity is constrained

• Neonatal capacity is constrained

• In utero referral can take HOURS

• Not everyone understands the impact a failed IUT may have on newborn outcomes

• It is difficult when you are busy to take time to recognise the importance of a maternity problem that is outside your hospital

IUT Task and Finish Group

• Set up: representation from NHSE, midwives, obstetricians, neonatologists

• Draft guideline written

• Start of consultation period

What does the guideline offer?

• Information about who should be transferred • Who should be transferred • Who shouldn’t be transferred

• Advice re risk stratification to reduce unnecessary transfers • Best practice toolkit for predictive testing • QUIPP app

• Advice re finding a cot • EBS • Cotfinder

• Guidance re referral process to improve the likelihood of acceptance

• Information about neonatal care

• Information about LAS response

• Guidance for need for escort

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Description

Those of us who have previously attempted to arrange an In- utero Transfer know how agonising is the pain of

finding the contact details for the different hospitals, and knowing exactly which hospital are within the neonatal

network that your hospital belongs.

This App is designed to help maternity staff easily show the contact details of the hospitals within a certain region,

arranging them by network, level and distance from the referring hospital. Accordingly, it will arrange search results

in order of relevance.

With the advantage of a live database of hospital status and contact details, we hope to make the transfer process

more streamlined, by indicat ing the hospitals that are most likely to accept the referral.

Currently the database has been set up for the London region, United Kingdom. To set up new regions, please

contact the Admin team on azaima@outlook.com.

Cot Finder Support

This app is designed for

both iPhone and iPad

Free

Category: Medical

Released: Mar 09, 2017

Version: 1.0

Size: 19.8 MB

Language: English

Seller: Ahmed Zaima

© Ahmed Zaima

Rated 4+

Compatibility: Requires

iOS 10.0 or later. Compatible

with iPhone, iPad, and iPod

touch.

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Cotfinder

• Available on iPhone & online

• Decision support for level of unit for gestation and neonatal networks

• Contact numbers for labour wards and neonatal units

• Neonatal cot availability declared by neonatal units • NNUs can update at any time

• EBS will update twice daily

Specific points of importance

• Use of predictive testing to focus IUT to high risk for delivery

• Maternity units using Cotfinder app (assisted by EBS) to focus referrals to units most likely to accept

• Standardising acceptance process to reduce workload of referring unit • One phone call for referrer • Internal conversation at receiving unit between NNU & Maternity • Consultants must be involved in decision to refuse • 1 hour between referral and answer

• Decision-making for staff to accompany women on transfer

• Documentation should be available for audit and investigation of ‘failed’ transfers

Work still to do

• Can we have more support to organise the whole transfer? • Scoping of resources needed by EBS

• Standardised transfer document to allow audit and exception investigations

• All units to sign up: referrers AND receivers

• Culture change?