Teamwork in Retrieval Medicine National Transport Medicine Programme Dr David Menzies National Lead, Adult Retrieval

Transport vsRetrieval ‘Sending’ patient Model 2, 3, (4) hospital to higher level of care Local team 999 Ambulance Non standardised ‘Collecting’ patient May add to level of care delivered Specialised team Critical Care Ambulance Standardised Training Equipment SOPs

NTMP - Vision Comprehensive Retrieval-Transfer system: Available to all infants, children and adults within Ireland Integrated with and supports Model 2, 3 and 4 Hospitals Provides bi-directional inter-facility transport for patients with needs ranging from Critical Care to Intermediate Care Prioritises clinically urgent as well as non-clinically (system) urgent patients Cross Programme participation and collaboration

NTMP - Key Deliverables 1.Integrated system of clinical co‐ordination and operational tasking 2.Transport clinical staff who are skilled in the planning and delivery of emergency/critical care medicine 3.Standardised equipment for ground and air transport 4.Collection of transport data for systematic clinical and operational activity review and audit 5.An education programme that supports the programmes objectives

Integrated Programme Governance Audit Education AdultPaediatricNeonates NAS (Air Corps)

NTMP Team Clinical Lead Dr Dermot Doherty, Anne McCabe Adult Retrieval (MICAS) Dr David Menzies, Anna Marie Murphy Paediatric Retrieval (IPATS) Dr Cormac Breathnac, Lorraine Heery Neonatal Retrieval (NNTP) Dr Jan Franta, Anne Bowden

Model Neonatal Expansion to 24/7 service Paediatric Develop 5 day (daytime) retrieval service Adult Develop 7 day (12 hours) retrieval service based in Dublin, Cork & Galway Dublin – built on existing MICAS service NAS Support for Transport Programme

Governance Steering Committee Oversight of quality metrics / audit Four separate funding streams aggregated into the NTMP “Shared Service” Offices in North Frederick Street allowing co-location of Neonatal, Paediatric and Adult Retrieval Coordinators

Neonates Built upon the existing neonatal service From 2 nd December 2013  24/7 service  Service delivered by 3 hospitals - 1 week in 3  200 transfers since going 24/7 (66% after 5pm, 70% outside Dublin)  Estimated transfers / year (from ) Clinical Lead Dr Jan Franta (from April 2014) Education  Cross hospital multi-disciplinary induction programme  July 2013 and January 2014

Paediatrics No existing service and centralised model of care  400 – 450 external transfers/year  Of which are neonates Plan for day time Monday to Friday service  Change to model of implementation agreed using locum consultants Clinical lead Dr Cormac Breathanch (0.2wte) Outreach education to referring hospitals  Initial session to all referring paediatric units during 2013  Sharing knowledge and improving pathways of communication Combined Neonatal & Paediatric Specialist Retrieval Expert Group, inaugural meeting April 2014

Adults Build on existing MICAS service  Day time Monday – Friday  Does not meet demand (estimated at 1200 transports / year) Plan:  7 day week services 08:00 – 20:00 in Dublin, Cork and Galway Interim Lead Dr Rory Dwyer Adult Specialist Retrieval Expert Group inaugural meeting January 14

Ambulances 999 v ICVs  Decision - ICVs unsuitable for critical care transport  But only small proportion of inter-hospital transfers New ambulances for neonatal transport Protocol 37  To ensures inter-hospital transports given appropriate priority alongside 999 calls

Education and Training Training programme to meet needs of: Retrieval teams Referring hospitals Why outreach? NTMP model means that referring hospitals will continue to undertake some of their own transfers Will ‘always’ have to do time critical transfers Outreach education 27 sessions in 2013 S.T.A.B.L.E course delivered neonatal & paediatric units Positive evaluation Builds relationships with referring teams Retrieval training Initial course delivered Cork Plan for 12 regional 1 day courses this year

Considerations / Future Recruitment – Issue particularly for adult / paediatrics Adaptation of implementation model More retrieval less transport Joint ownership of referred patient Further work on single point of contact for all retrievals Further integration transport equipment / platforms Development of lower level patient transfers Partnership working

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