TRANSPORT ANNUAL REPORT 2015 Dr Jean Matthes, Clinical Transport Lead Claire Richards, CHANTS Service Manager Jacqui Davies, Business Support Officer

TOTAL TRANSPORT ACTIVITY 528 transfers were performed by CHANTS during 2015 187 (35%) Uplifts 220 (42%) Repatriations 121 (23%) Capacity Since 2013 more uplifts and more capacity repatriations Consultants delivered 89% uplifts, 50 % capacity and 50% repatriation transfers

BAPM CARE LEVELS Of the 528 transfers there were: 178 Intensive Care (34%) 127 High Dependency Care (24%) 223 Special Care (42%) 130 ITU transfers were Uplifts 26 ITU transfers were for Capacity.

VENTILATION STATUS Since Hi-Flow became available, the number of babies transferred using this respiratory support has increased. The availability of Hi-Flow on the smaller units contributes to this rise. Of the 89 ventilated transfers during ‘Uplift’, 6 babies also received Nitric Oxide therapy.

UPLIFT TRANSFERS The number of Uplift transfers undertaken for Medical reasons has remained fairly consistent over the previous years.

OPERATIONAL REASON FOR TRANSFER OF INFANTS <32 WEEKS IN THE FIRST 3 DAYS OF LIFE Gestation at birth Uplift Capacity Repatriation 23+0 – 26+6 10 27+0 – 31+6 26 13 2 32 week model introduced across the Network during 2015

NTG BENCHMARKS 19 neonatal transport services across the UK

Service Characteristics all %

BENCHMARK 1 TIME CRITICAL TRANSFERS - WHERE THE TEAM SHOULD DEPART BASE <1HR FROM THE START OF THE REFERRING CALL Time Critical Within 1hr Total Number of transfers requests received to which a team was despatched 13 36 49 Number to which a team was dispatched within 60 minutes of the start of the referring call 9 25 34 70% of these referrals for CHANTS had a team despatched within 60 minutes of the referring call. Compared with 81% for whole of UK

BENCHMARK 2 DEDICATED NEONATAL TRANSPORT SERVICES TRANSFER AT LEAST 95% OF PATIENTS REQUIRING UPLIFT (WITHIN A DEFINED CATCHMENT AREA) Number of infants referred from a Welsh neonatal unit for transfer where the primary operational reason is uplift of care 187 Number of infants transferred for uplift of care by another transport service or neonatal unit 42 CHANTS only able to achieve 83% as it is a single 12 hour service. In UK 97% of these transfers are done by the commissioned team Of the 42, 24 were transferred OOH and 14 within hours when CHANTS was busy

Neonatal Transport Services transfer at least 95% of patients requiring transfer for uplift within its defined catchment area. (%)

BENCHMARK 3 THE TRANSPORT TEAM WILL ARIVE WITH THE PATIENT (UPLIFT, ITU PATIENTS) WITHIN 3.5HRS OF REFERRAL CALL Infants transferred by the team where the classification is based on intention at the time of team departure was ‘ITU’ and the operational reason is ‘Uplift’ 130 Of the above, number where the team arrived with the patient within 3.5hrs of the start of the referral call 107 The team arrived with the patient within 3.5hrs for 82% of the transfers Compared with 83% across UK

Team arrived with the patient within 3 Team arrived with the patient within 3.5 hours of the start of the referring call (Intensive care; uplift) (%), Jan-Jun/year. 2013: 72% (n=1689) 2014: 86% (n=1836) 2015: 83% (n=1945)

BENCHMARK 4 COOLING Number of infants transferred for cooling 19 Number of infants >6hours of age on completion of transfer 10 (9 born out of hours) Number of infants >6hours of age with temperature 33-34°C on completion of transfer 7 Number of infants intubated and ventilated at time of transfer 11 Number of infants intubated and ventilated with pC02 <4kPa on the gas measurement on completion of transfer 2 Summer 2015 saw all 3 teams able to deliver active therapeutic cooling Of the 19, only 6 babies were transferred using active therapeutic cooling 1 team can only facilitate active therapeutic cooling if the referral is made when the team is at base

BENCHMARK 5 OVERVENTILATION AND UNDERVENTILATION A. Number of ventilated transfers (not CPAP etc.) 107 B. Number of ‘A’ with a pCo2 on completion of transfer 91 Number of ‘B’ with a pCo2 <4kPa on the gas measurement on completion of transfer 7 (8%) Number of ‘B’ with a pCo2 >7kPa and a pH < 7.2 on the gas measurement on completion of transfer

NTG audit of babies transferred for bilious vomiting 3 months survey of infants >37 weeks gestation referred for bilious vomiting < 7 days with no known congenital abnormality Results 165 babies , median gestation 40 weeks, median bwt 3.46 kg median age at transfer 28 hours

Results – final diagnosis Number Percentage Normal 98 65 Suspected sepsis 11 7 Sepsis 1 Viral Meningitis gallstones GORD 5 3 Meconium aspiration syndrome TOTAL 118 71

Results final diagnosis - surgical number percentage Malrotation 7 5 Malrotation plus volvulus 3 2 Ileal atresia Hirschsprungs conf or susp 11 Anal stenosis 1 Colonic atresia Duodenal obstruction NEC conf/susp 4 Meconium ileus Meconium plug TOTAL 34 20

Next steps Commission 24 hours service in South Wales, OP for working with Bristol OOH. Bristol will provide an Ad hoc team when possible for uplift emergency transfers only Conference calls including OOH Further training of referring units particularly with respect to initial management of HIE babies Incident report babies who require cooling but are not at target temperature by 6 hours. Further work with EMRTS including trial of access to helicopter transfers. Training of WAS paramedics re stabilisation and transfer of newborn babies. Revitalise / reinvent the CHANTS web site.