Census of neonatal transfers in London and the South East of England

Abstract

Objectives: To determine the number and characteristics of inter-hospital transfers of newborn infants in London and the South East of England.

Design: Prospective census of neonatal transfers over a three month period.

Setting: Transfers between the 53 hospitals that provide care for newborn infants within the former Thames regions.

Data sources: Census returns from participating neonatal units.

Main outcome measures: Number, timing, and hours of staff time spent on transfers. Gestation, birth weight, and reason for transfer of the baby. Time elapsed between request and retrieving team departing and arriving with patient.

Results: A daily average of 2.7 urgent, 3.5 elective, and 0.7 short term transfers took place during the census period. The most common reason for urgent transfer was neonatal surgery. Neonatal unit staff spent an average of 21 hours a day off their units accompanying transfers each day. It took over four hours for 90% of ambulances to set off with the retrieving team and over six hours for 90% of teams to reach the baby.

Conclusions: During the census period, services for the transport of neonates in London and the South East of England involved long delays and used appreciable amounts of staff time. It is likely that a small number of dedicated neonatal transfer teams could meet the needs identified in this census more effectively than the 53 hospitals currently involved.

Figure 1

Geographical area covered by the census. Patient flows are indicated as numbers during the three month census travelling between or within each area (red, urgent; blue, elective).

Figure 2

Daily transfer activity. Frequency distribution of the daily number of transfers, with the cumulative percentage distribution shown on the right y axis.

Figure 3

Time elapsed after the need and destination of transfer had been confirmed. Values are the number of retrievals in each time window, firstly for the arrival of the ambulance with the transferring team and secondly for the time elapsed from the call to the team arriving with the patient. Cumulative percentage curves are also shown.