Neonatal Transport Group.Birmingham 2013.

Andy LeslieChair of NTG.

What’s to come

• NTG activity summary.• Data returns. • The year ahead.

NTG Report.

• BAPM memorandum of understanding.• External assessment/accreditation of

teams. • Incident reporting and sharing system. • Air transport. • Membership.

Commissioning

• Scotland – planning new services from April 2014.

• Wales – Provision for N. Wales added• N. Ireland – 24 hour service and PIC links

explored. • England – service specification for

neonatal transport services written for NHS England via Neonatal CRG.

Dataset/IT platform

• Dataset 2012 version unchanged– Some nips & tucks may be needed.

• Tighten some definitions.• Add some filters.

– Comparing quality between services.

• Some progress with an IT spec.

Data 2013

Method

• Email to transport service’s medical and nursing leads requesting activity data from 1.1.13 to 30.6.13

• Brief additional information about each service.

Number of services…

• 2012 – data from 22• 2013 – data from 21

– Kent/Surrey/Sussex reported from 3 services in 2012 and from one service this year.

– N. Wales added.

UK summary data Jan-Jun 2012 & 2013

2012 2013Total transfers 7152 7562Ventilated 1889 (26%) 1961 (26%)

CPAP/high-flow 847 (12%) 906 (12%)

Cooling 247 (3%) 288 (4%)

iNO 99 (1%) 111 (1%)

On inotropes 420 (6%) 447 (6%)

Service Characteristics (n=21)

02468

1012141618

24hrs Dedicatedvehicles

Cot bureau Conf. calls

20122013

Consultants

0

2

4

6

8

10

12

14

All Some Ad-hoc None

• Consultant availability to attend transfers: – Scheduled, all of the

time.– Scheduled, some of

the time– Maybe available, ad-

hoc.– Never available to

attend.

Total Transfers/team, Jan – June 2013

0

100200

300

400500

600

700800

900

Total Transfers/team Jan – June 2012/2013

0

100

200

300

400

500

600

700

800

900

N. Sco

t

W.S

cot

SE Sco

t

CONNECT N Ir

eland

STaRS C

umbr

ia

Newcastl

e

CMNTS Mers

ey

GMNeTS Man

ches

ter

Middles

broug

h

Embrace

Yorks

& H

umbs

CenTre

W M

ids N

TS

ANTS Ang

lia

CHANTS S W

ales

N Wales

Oxford

Thames

Vall

ey

NEST Bris

tol

Lond

on N

TS

KSS Kent

Surrey

Sus

sex

Solent

Penins

ula

Total Transfers 2012

Total Transfers 2013

Increased: 10

Decreased: 8

Average number ventilated transfers/week Jan – June 2012 & 2013

0

2

4

6

8

10

12

14 2012

2013

Number transferred for cooling or assessment for

cooling, Jan – June 2012 & 2013

0

10

20

30

40

50

60 20122013

Total for UK

2012: 247

2013: 288

Number transferred on iNO – Jan – June 2012 & 2013

0

5

10

15

20

25

30

35

40

N. S

cot

W.S

cot

SE

Sco

t

CO

NN

EC

T N

STa

RS

New

cast

le

CM

NTS

GM

NeT

S

Mid

dles

brou

gh

Em

brac

e

Cen

Tre

W M

ids

NTS

AN

TS A

nglia

CH

AN

TS S

N W

ales

Oxf

ord

NE

ST

Bris

tol

Lond

on N

TS

KS

S K

ent

Sol

ent

Pen

insu

la

2012

2013

Total for UK

2012: 99

2013: 111

Time standards

Data on – Time critical (all)– Time critical at base– Referral response time (all)– Uplift transfers performed

% of time critical transfers team mobile within 60 minutes of start of referring call.

% of time critical transfers team mobile within 60 minutes of start of referring call.

0%10%20%30%40%50%60%70%80%90%

100%

13 48 40 39 17 24 13 40 40 17 11 34 68 11

% of time critical transfers team mobile within 60 minutes of start of referring call (all

calls & calls taken at base)

0102030405060708090

100 All

At base

Team arrived with the patient within 3.5 hours of the start of the referring call

(Intensive care; uplift) (n=)

• Problem with inclusion of infants for elective or semi-elective procedures (e.g. PDA ligation).

Team arrived with the patient within 3.5 hours of the start of the referring call

(Intensive care; uplift) (%)

0102030405060708090

100

N. Sco

t

W.S

cot

SE Sco

t

CONNECT N Ir

eland

STaRS C

umbri

a

Newca

stle

CMNTS Mer

sey

GMNeTS M

anch

ester

Middles

brou

gh

Embrac

e Yor

ks &

Hum

bs

CenTr

e

W M

ids N

TS

ANTS Ang

lia

CHANTS S

Wale

s

Oxford

Thames

Vall

ey

Lond

on N

TS

KSS Ken

t Surr

ey S

usse

x

Solent

Penins

ula 25 14 33 24 17 67 46 98 47 169 145 136 202 61 25 325 160 50 36

Neonatal Transport Services transfer at least 95% of patients requiring transfer for uplift within its

defined catchment area. (%)

• Counting what we don’t do is difficult.

Neonatal Transport Services transfer at least 95% of patients requiring transfer for uplift within its

defined catchment area. (%)

Neonatal Transport Services transfer at least 95% of patients requiring transfer for uplift within its

defined catchment area. (%)

50556065707580859095

100

N. Sco

t

W.S

cot

SE Sco

t

STaRS C

umbri

a

Newca

stle

CMNTS Mer

sey

GMNeTS M

anch

ester

Middles

brou

gh

Embrac

e Yor

ks &

Hum

bs

CenTr

e

W M

ids N

TS

ANTS Ang

lia

CHANTS S

Wale

s

Oxford

Thames

Vall

ey

Lond

on N

TS

KSS Ken

t Surr

ey S

usse

x

Solent

Penins

ula 71 65 61 44 111 162 141 54 318 256 237 290 84 134 396 259 87 66

Over-ventilation

% of uplift and resources/capacity transfers, ventilated in transit with pCO2 <4 kPa on the gas measurement on

completion of transfer, UK

% of uplift and resources/capacity transfers, ventilated in transit with pCO2 <4 kPa on the gas measurement on

completion of transfer, UK

•Note that not all infants had pCO2 available post-transfer.

% of uplift and resources/capacity transfers, ventilated in transit with pCO2 <4 kPa on the gas measurement on

completion of transfer, UK

Alln=

pCO2 <4 kPa

n=

pCO2 <4 kPa

%

All uplift & resource

1355 118 9

Uplift 1273 112 9

Resource 82 6 7

% pCO2 <4 kPa on completion , per service.Jan – June 2013.

0%

5%

10%

15%

20%

25%

30%

N. Sco

t

W.S

cot

SE Sco

t

CONNECT N Ir

eland

STaRS C

umbri

a

Newca

stle

CMNTS Mer

sey

GMNeTS M

anch

ester

Middles

brou

gh

Embrac

e Yor

ks &

Hum

bs

CenTr

e

W M

ids N

TS

ANTS Ang

lia

CHANTS S

Wale

s

Oxford

Thames

Vall

ey

NEST Bris

tol

Lond

on N

TS

KSS Ken

t Surr

ey S

usse

x

Solent

Penins

ula

17 31 34 10 13 60 32 79 33 106 133 17 153 50 53 65 246 141 41 31

% pCO2 <4 kPa on completion , per service.Jan – June 2013.

0%

5%

10%

15%

20%

25%

30%

N. Sco

t

W.S

cot

SE Sco

t

CONNECT N Ire

land

STaRS C

umbri

a

Newca

stle

CMNTS Mers

ey

GMNeTS M

anch

ester

Middles

broug

h

Embrace

York

s & H

umbs

CenTre

W M

ids N

TS

ANTS Ang

lia

CHANTS S W

ales

Oxford

Thames

Vall

ey

NEST Bris

tol

Lond

on N

TS

KSS Ken

t Surr

ey S

usse

x

Solent

Penins

ula 17 31 34 10 13 60 32 79 33 106 133 17 153 50 53 65 246 141 41 31

*

*

* *

*

% pCO2 <4 kPa on completion , per service.Jan – June 2013.

0%

5%

10%

15%

20%

25%

30%

N. Sco

t

W.S

cot

SE Sco

t

CONNECT N Ire

land

STaRS C

umbri

a

Newca

stle

CMNTS Mers

ey

GMNeTS M

anch

ester

Middles

broug

h

Embrace

York

s & H

umbs

CenTre

W M

ids N

TS

ANTS Ang

lia

CHANTS S W

ales

Oxford

Thames

Vall

ey

NEST Bris

tol

Lond

on N

TS

KSS Ken

t Surr

ey S

usse

x

Solent

Penins

ula 17 31 34 10 13 60 32 79 33 106 133 17 153 50 53 65 246 141 41 31

*

*

* *

*BP

StefFab BLBP BP BP

Stef

BPStef

Fab

BP

BP

BP

Stef

Stef

BP

Stef

Fab

BP

Stef

Stef

Stef

BL

Stef

Fab

BP

% pCO2 <4 kPa , per service, ETCO2.

0%

5%

10%

15%

20%

25%

30%

N. Sco

t

W.S

cot

SE Sco

t

CONNECT N Ire

land

STaRS C

umbri

a

Newca

stle

CMNTS Mers

ey

GMNeTS M

anch

ester

Middles

broug

h

Embrace

York

s & H

umbs

CenTre

W M

ids N

TS

ANTS Ang

lia

CHANTS S W

ales

Oxford

Thames

Vall

ey

NEST Bris

tol

Lond

on N

TS

KSS Ken

t Surr

ey S

usse

x

Solent

Penins

ula 17 31 34 10 13 60 32 79 33 106 133 17 153 50 53 65 246 141 41 31

*

*

* *

*

No end-tidal

Data, summary

• Data-rich environment. • Tipping point.• There’s lots more we can do!• Measure what’s meaningful, not just

what’s measureable.

NTG

• Embrace the quality agenda. – Data – hypothesis generation & shared

projects.– Incident sharing.– Promoting patient-focussed best practice.– Benchmarking.

• Support the profession.

Time critical transfers, all, n= Jan – June 2012 & 2013

0

10

20

30

40

50

60

70

80

>60 mins

<60 mins

Team arrived with the patient within 3.5 hours of the start of the referring call

(Intensive care; uplift) (n=)

0

50

100

150

200

250

300

350

N. Sco

t

W.S

cot

SE Sco

t

CONNECT N Ir

eland

STaRS C

umbr

ia

Newcastl

e

CMNTS Mers

ey

GMNeTS Man

ches

ter

Middles

broug

h

Embrace

Yorks

& H

umbs

CenTre

W M

ids N

TS

ANTS Ang

lia

CHANTS S W

ales

Oxford

Thames

Vall

ey

Lond

on N

TS

KSS Kent

Surrey

Sus

sex

Solent

Penins

ula

>3.5 hrs

<3.5 hrs

Neonatal Transport Services transfer at least 95% of patients requiring transfer for uplift within its

defined catchment area. (n=)

050

100150200250300350400450

N. Sco

t

W.S

cot

SE Sco

t

STaRS Cumbri

a

Newca

stle

CMNTS Mers

ey

GMNeTS M

anches

ter

Middles

brough

Embrace

York

s & H

umbs

CenTre

W M

ids NTS

ANTS Angli

a

CHANTS S W

ales

Oxford

Thames

Vall

ey

Lond

on NTS

KSS Kent

Surrey S

usse

x

Solent

Penins

ula

Done by other

Done by team