transport medicine programme: retrieval and transfer april 2013

Transport Medicine Programme:

Retrieval and Transfer

April 2013

TRANSPORT MEDICINE (RETRIEVAL‐TRANSFER) PROGRAMME

PHECC is an independent statutory body with responsibility for standards, education and training in the field of pre hospital emergency care


Dr Aine Carroll – National Director of Clinical Strategy and ProgrammesDr Geoff King – Lead

Steering Committee:

• Dr Michael Power, Critical Care Lead• Dr Una Geary, Emergency Medicine Lead• Dr Cathal O’ Donnell, Medical Director, National Ambulance Service• Dr Garry Courtney, Lead Acute Medicine• Prof Alf Nicholson, Paediatric Lead• Dr John Murphy, Neonatology Lead• Dr Michael Turner, Obstetrics Lead• Dr Bairbre Golden, Anaesthetics Lead• Prof Frank Keane, Lead Acute Surgery• Office of the Nursing and Midwifery Services Director

• Others

Primary Care Patients Clinical Strategy and Programme Directorate

To oversee o the establishment of a comprehensive Retrieval-

Transfer system that: is integrated with and supports the integration of

Model 2, 3 and 4 Hospitals provides bi-directional inter-facility transport for

patients with needs ranging from Intermediate Care to Critical Care

prioritises clinically urgent as well as non-clinically (system) urgent patients

o cross Programme participation and collaboration


Steering Committee

Aims:

Service Model

The service model proposed is fully integrated within the broader healthcare system and is evolved from existing services for pre-hospital emergency care and acute hospital care. The model encompasses Adult, Paediatric and Neonatal Retrieval-Transfer.

Context:• Reconfiguration of Acute Health Services• Small Hospitals Framework• Hospital Groups Strategy


Key deliverables:

1) An integrated system of clinical co‐ordination and operational tasking2) Transport clinical staff who are skilled in the planning and delivery of emergency/critical care medicine3) Standardised equipment for ground and air transport4) Collection of transport data for systematic clinical and operational activity review and audit5) An education programme that supports the programmes objectives.

Retrievals/Transfers

CurrentADULTMICAS 70Aircorps 80Coastguard small number

NEONATALNNTP 2507 days, daytime

EstimatedADULT> 1,000 total Anticipated 2012 and ongoing Anticipated 2012 and ongoingPAEDIATRIC250NEONATALAdditional 100

What is Required

PAEDIATRIC Retrieval-Transfer• One 24/7 team in Dublin

NEONATAL Retrieval-Transfer• One 24/7 team in Dublin ? One 5 or 7 day, daytime team in

Cork

ADULT Retrieval-Transfer• Two 24/7 teams in Dublin, one

north-side, one south-side • One 24/7 team in Cork• One 24/7 team in Galway ? One 5 or 7 day, daytime team in

Sligo/Letterkenny? One 5 day, daytime team in

Limerick ? One 5 day, daytime team in

Waterford

What is Funded

PAEDIATRIC Retrieval-Transfer• One 5/7 daytime team in Dublin

NEONATAL Retrieval-Transfer• One 24/7 team in Dublin

ADULT Retrieval-Transfer• One 8 to 8, 7 day team in Dublin,

Cork and Galway

• Establishment of IC Ambulances in Dublin, Cork and Galway and also Drogheda, Sligo, Castlebar, Limerick, Tralee, Bantry and Waterford

CurrentlyOne 7 day, daytime Retrieval team (NNTP) in Dublin (circa 250 patients per year)

NEONATAL RETRIEVAL SERVICE

What is fundedOne 24/7 Retrieval team in Dublin

Estimated circa 100 additional patients per year

PAEDIATRIC RETRIEVAL SERVICE

CurrentlyNo Retrieval team. Estimated circa 250 patients per year

What is FundedOne 5/7 daytime Retrieval team in Dublin

ADULT RETRIEVAL SERVICE

CurrentlyOne 5 day, daytime Retrieval team (MICAS)(circa 70 patients per year)

What is FundedOne 8 to 8 7 day Retrieval team in Dublin

What is FundedOne 8 to 8 7 day Retrieval team in Cork

What is FundedOne 8 to 8 7 day Retrieval team in Galway


ADULT RETRIEVAL SERVICE

CurrentlyOne 5 day, daytime Retrieval team (MICAS)(circa 70 patients per year)

What is FundedOne 8 to 8 7 day Retrieval team in Dublin

Establishment of IC Ambulance in Dublin

What is FundedEstablishment of IC Ambulance in Waterford

What is FundedOne 8 to 8 7 day Retrieval team in Cork

What is FundedEstablishment of IC Ambulance in Limerick

What is FundedOne 8 to 8 7 day Retrieval team in Galway

What is FundedEstablishment of IC Ambulance in Sligo


What is FundedEstablishment of IC Ambulance in Drogheda

What is FundedEstablishment of IC Ambulance in Castlebar

What is FundedEstablishment of IC Ambulance in Tralee

What is FundedEstablishment of IC Ambulance in Bantry

AIR CORPS

Currently80 Retrievals - Transfers per annum

Anticipated increase in 2012 and ongoingLocationsDublin and Athlone

COASTGUARD

CurrentlySmall number of Retrievals - Transfers

Anticipated increase in 2012 and ongoingLocationsDublin, Waterford, Shannon and Sligo.

Key Solution Areas/Strategic Opportunities

• Workforce Model

? Australia/UK ( Adult) versus

? North America (? Neonatal, ? 10 year timeframe)

• Clinical Co-ordination Neonatal IC “bed bureau” Paediatric IC telephone “bridge” and on-line support

NEONATAL Retrieval-Transfer

Towards A National Neonatal Bed Management System

Ann BowdenThe National Neonatal Transport

Programme (NNTP)March 2012

Method

• Information gathered through the NNTP website at www.nntp.ie

• Each hospital/unit has a unique access code to the webpage

• Pages individualised for each hospital• Information entered each day (ideally!) but

can be retrospective• Daily/monthly/annual reports instantly

available as desired on occupancy, transfers out etc

http://www.nntp.ie/

Information gathered• Numbers of babies in each unit at 10 am each day• Levels of care required as per BAPM Guidelines 2001,

(Now 2011), • Reasons if closed for admissions• Number of transfers in/out in the last 24 hours:

– Hospital to/from, Time, Reason, Birth Wt., Birth Gest., D.O.B., Team.

• No. of critical transfers not carried out by NNTP and why?

• No. Antenatal Transfers Accepted /Refused( Tertiary centres only)– Optional Staffing levels

All Critical Care Transports (n=479): NNTP (n=286), Non NNTP by Reason (n=193)

(26) 5%(56)12%

(109)23% (286)60%

(2)0.4%

NNTP Team Transports

Out of NNTP Service Hours

NNTP Engaged with Another Call

Transport Too Urgent to Await Arrival opf NNTP

ECMO Team Transports

122

134

38

3463

14

52

22

0

50

100

150

200

250

300

< 48 hours 48 hours - 1 wk 1 wks - 1 month > 1 month

Non NNTP

NNTP

Infant Age of When Transported 53% (256) were <48hrs old

Critical Care Transports Sep.2010-11 by Reason (n=479)1. CHD = 21% (101), 2. GIT = 13% (63),3. Prem.= 13% (61), 4. PDA = 11% (55).

8 830

7

4335

40 47

3024

104

58

28 21 8

7 12

118 10 6 6

18

0

20

40

60

80

100

120

NON- NNTP

NNTP

5

54

208

62

73

77

0

50

100

150

200

250

300

00.00-09.00 09.00-17.00 17.00-00.00

Non NNTP

NNTP

Time of Critical Care Transports in ROI Sept. 2010-11 44% (209) occurred between 17.00 hrs and 09.00hrs

NNTP TRANSFERS TO NMH (SEP 2010-SEPT 2011)

Mayo

Letterkenny

Waterford

Kilkenny

Cavan

Sligo

Drogheda

Tipperary

Portiuncula

Portlaoise

Limerick

Wexford

Longford/Westmeath

Transfers to NMH

Cavan 3

Letterkenny 2

Limerick Regional 1

Longford Westmeath Hospital 2

Mayo General Hospital 5

Our Lady of Lourdes Drogheda 1

Portlaoise Hospital 1

Portiuncula Hospital 9

Sligo General Hospital 1

St Luke's Kilkenny 3

Temple Street 1

Wexford General 1

Waterford Regional Hospital 2

Total Transfers 32

Returns


Portiuncula Hospital 1

St Luke’s Kilkenny 1

Total Returns 3

Temple Street

1-5 Transfers 6-10 Transfers11-15 Transfers

NON NNTP TRANSFERS TO NMH (SEP 2010-SEPT 2011)

Cavan

Cavan General 2

Longford Westmeath 5


Portiuncula 4

Sligo General Hospital 1

South Tipperary General Hospital 1

Wexford General Hospital 1

Total Non NNTP Transfers to NMH 15

Portiuncula

After NNTP Service HoursNNTP engaged with another callTransport too urgent to wait arrival

2

Drogheda

Wexford

Tipperary

Longford/Westmeath

Sligo

34

PAEDIATRIC Retrieval-Transfer

Access to PICU Bed1890213213

Phone call to designated phone line number: 1890213213- effective February 2012

Bridge phone line: appropriate consultants can be brought in on call

Consultant preference for bed will be considered

Decision made by Intensivists/medical team as to right place for patient

Goal timely access to critical care bed

Retrieval team vital for this

IPCCN Web Page: www.picu.ie

• 1ST access Welcome page; phone number here • Initial log in/ then individual password.• Steps for referral Links on page:• On-line transfer request form, complete and submit

All patient information encrypted/data protected

• Calculator - drop down menu: drug doses/ wt / E.T.T./Maintenance fluids/oxygen requirements for journey

• Clinical guidelines – specific conditions

Operational Tasking

Centralisation of Ambulance Communication into one/two centre(s)

Establishment of a National Aeromedical (sic) Co-ordination Desk by National Ambulance Service in response to HIQA Report

Training

Funding for the development of a Training /Induction Course

- HSE-MET- PHECC

Transport Vehicle

Separation of EMS and PTS by the National Ambulance Service; establishment of an IC Ambulance fleet

Standardisation of equipment on trolleys, not vehiclesX HIQA EMS Response Time Standards

Helicopter(s)

Establishment of National Aeromedical Co-ordination Group by the HSE in response to HIQA Report.- Aeromedical Service Provider Standards

Establishment of a dedicated Air Corps helicopter in Athlone.

Equipment

Coroners Report reference to Intra-Aortic Balloon Pumps

MICAS hospitalsOther centres with interventional cardiology

Funding

? Currently 3 funding streams

? Commissioning of services

Governance

? NNTP Committee

? PCCN Implementation Committee

? MICAS Committee

National Paediatric Hospital

Summary

MICAS and the NNTP collectively provide a platform from which to develop a comprehensive Retrieval - Transfer capability. Implementation is suggested by expanding capability and enhancing access.

1. Expansion of Adult Retrieval in Dublin to 7 days, and establishment in Cork and Galway.

2. Expansion of Neonatal Retrieval to 24/7. 3. Establishment of Paediatric Retrieval in Dublin, 5 days.

4. The aim is to ultimately develop a high quality Retrieval - Transfer system that is accessible to patients and hospitals dispersed across Ireland, and has the capacity to transport several patients simultaneously.


= other Programmes

Goal Optimal utilisation of national health services.

Guiding Principle As a general principle the strategic matching of resources to the needs of patients is both effective and efficient.


v other Programmes

Programme Service

Right Care, Right Time, Right Place

Ensuring a high quality Retrieval and Transfer service for seriously ill babies,

children and adults

Thank You

Any questions?

transport medicine programme: retrieval and transfer april 2013

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