west midlands neonatal transfer service wmnts activity april 2012-march 2013

West Midlands Neonatal Transfer Service

WMNTS Activity

April 2012-March 2013

Who We Are


Operational Policy

Provide 24/7 retrieval service Provide daily back transfer service 9-5 Monday-Friday cot locator service

Retrieve from neonatal units or neonates from BCH/Alder Hey

Transfer numbers

Refusals

Data collection

Types of Transfers

Time critical transfers

Staffing

Clinical Incidents

Budget

Changes


Transfers 2009-2013

2009-2010 2010-2011 2011-2012 2012-20130

200

400

600

800

1000

1200

1400

1600

18001698

1553

1390

1547

1422

1253

10741180

Requested Performed


Activity 2012-13

April

May

June Ju

ly

Augus

t

Septe

mbe

r

Octobe

r

Novem

ber

Decem

ber

Janu

ary

Febru

ary

Mar

ch0

20

40

60

80

100

120

140117

157

121126

133125

143 137 158

123

100107

94

109

82

10298 99

115

101110

97

86 87

Req Trans Prev yr


SWMNN SSBCNN CNN Other

Requested 1016 369 48 114

Performed 789 281 23 87

100

300

500

700

900

1100

Activity by Network 2012-2013

Tra

ns

fer

nu

mb

ers

Other includes repatriation from LWH, Alder Hey, Bristol(s), Arrowe Park)

Transfer numbers

Refusals

Data collection

Types of Transfers


Staffing

Clinical Incidents

Budget

Changes

REASON FOR NOT UNDERTAKING TRANSFERS

Attributable to NTS Non NTS

Number of Refusals StaffingOn other/ITU calls

Weather/Equipment

Deteriorationof baby

No beds Parents

Inapproprequest

Canc byref unit

Not in ournetwork

Canc by rec unit

SWMNN 71 6 23 3 20 19

SSBCNN 34 15 4 12 3

CNN 15 1 14

Other 7 1 3 3

Total 127 Number of Cancellations

SWMNN 139 40 10 35 4 3 35 1 11

SSBCNN 46 5 3 17 2 1 17 1

CNN 10 1 1 5 2 1

Other 17 7 5 1 3 1

Total 212

Number of Deferrals

SWMNN 17 11 1 1 2 1 1

SSBCNN 8 7 1

CNN 0

Other 3 1 1 1

Total 28

22 92 4 23 67 8 39 57 41 14


Transfers performed(1180)/ requested (1547)=

(76%)

But only 118 of those not performed were for WMNTS

reasons

Therefore (1547-118)/1547 could have been

performed by WMNTS = 92% (both networks)

Transfer numbers

Refusals

Data collection - old

Types of Transfers


Staffing

Budget

Clinical Incidents

Changes


Data Collection April 12-Dec 12

Transferred IPPV Surgical CardiacBack

transfer SpecialistOPD/

RadiologyCot

Mngt Cooling

Transfer numbers

Refusals

Data collection

Types of Transfers - old


Staffing

Clinical Incidents

Budget

Changes


Medical Transfers 12-13

SSBCNN SWMNN CNN Other Total0

20

40

60

80

100

120

140

160

Medical

Acute

Non Acute


Cardiac Transfers


10

20

30

40

50

60

70

80

Cardiac Acute

Non Acute


Surgical 12-13


50

100

150

200

250

SurgicalAcuteNon Acute


Surgical Transfers

219

5 3

Within care pathwayOutside care pathwayCare not available in region


Specialist 12-13


5

10

15

20

25

30

SpecialistAcuteNon Acute


Back Transfers 12-13


100

200

300

400

500

600

BackTransfersAcuteNon Acute


Cot Management


10

20

30

40

50

60

70

80

90

100

CotManagementAcuteNon Acute

Transfer numbers

Refusals

Data collection - new

Types of Transfers


Staffing

Clinical Incidents

Budget

Changes

Since Jan 13

Replaced by a 4-level categorisation

EVERY inter-hospital neonatal transfer categorised against these categories.


BAPM category of care

Intensive Care High dependency care

Special care

Pick ONE

Notes: Transitional care / normal care not included as basic monitoring used for all babies in transfer


Primary clinical reason for transfer

Medical Surgical Cardiac Neurological

Pick ONE

Categorise on the intended treatment the infant will receive on completion of transfer.


Primary operational reason for transfer

Uplift Resources/Capacity

Repatriation Outpatients

Pick ONENotes:

Uplift: Transfer for care that the referring centre does not normally offer


Time

Within 1 hour Within 24 hours

>24 hours

Pick ONE

Use intention to treat throughout. Within what timescale did you set-out to arrange this transfer?

Transfer numbers

Refusals

Data collection

Types of Transfers - new


Staffing

Clinical Incidents

Budget

Changes

Example – March 2013ITU 34 Uplift 41

HD 14 Capacity 13

SC 39 Repatriation 33

Out Patients 0

Medical 56

Surgical 22 Within 1 hr 2

Cardiac 1 Within 4 hrs 37

Neuro /cooling 8 (1+7) Within 24 hrs 47

>24 hours 1

Transfer numbers

Refusals

Data collection

Types of Transfers


Staffing

Clinical Incidents

Budget

Changes


Clinical criteria for categorising as Time Critical

1. Gastroschisis2. Ventilated infant with Tracheo-oesophageal fistula +/- atresia3. Intestinal perforation4. Suspected duct-dependent cardiac lesion not responding to

prostin5. Unstable respiratory or cardiovascular failure not responding

to appropriate management: Despite giving appropriate ventilation via endotracheal tube the

infant’s respiratory status remains unstable or severely compromised:

persistent unstable pneumothorax despite chest drain requiring FiO2 100%

arterial oxygen < 5kPa on 2 consecutive blood gas measurements pH <7.1 and pCO2 >9kPa persistent mean blood pressure below corrected gestational age,

measured on arterial line; if measured with cuff only, there should also be acidosis (pH <7.1)

Time Critical TransfersNIC01 - WMNTS Transfer Response Time

Response Times *or if born >same day, time call received

Date DiagnosisReferring Hospital

Receiving Hospital Vent mode

Time Baby Born

Time callreceived

Time callaccepted

Time team left base

Miles toref unit

Arrived refhospital

Miles to rec unit

Depart refhospital

Arrived rechospital

Total time (time born* - rec hosp) Comments

20.04.12 Perforated NEC Heartlands Alder Hey PICU IMV 09:04 15:50 15:55 16:15 8 16:40 98 18:35 20:20 11hrs 16minsAlderhey PICU bed lost upon arrival;theatre bed made available after 1.5 hours

30.04.12 Gastroschisis B'ham Women's BCH NNSU SVIA 11:25 11:55 11:55 12:05 0 12:10 4 13:25 13:55 2hrs 30minsDelay due to haematoma requiring Consultant review. Roadworks delayed journey outside BCH, Consultant in theatre when team arrived

06.05.12 Gastroschisis B'ham Women's BCH NNSU SVIA 12:59 13:40 13:40 13:40 0 13:45 4 14:50 15:15 2hrs 16mins

13.05.12 Gastroschisis B'ham Women's BCH NNSU SVIA 10:44 12:50 14:15

Team finished moving other

baby from BCH to BWH14:45 0 14:45 4 15:30 15:50 5hrs 6mins

WMNTS had to move a baby from BCH NNSU first to create cot space for this baby, therefore not able to obtain surgical review within 2 hour timeframe.

14.05.12RDS,Perforated NEC UHNS Alder Hey IMV

On8.05.12 15:15 15:15 16:00 66 17:25 55 19:35 20:40 5hrs 25mins

Team already out on transfer (Redditch) when call received, ambulance needed to be swapped due to broken door. Delay on motorway due to major incident, police contacted for alternative route

18.05.12 Perforated NEC UHNS BCH PICU SIMVOn

13.05.12 18:50 18:50 18:50 49 20:00 45 21:40 22:40 3hrs 50mins Outcome - no perforation, treated conservatively

25.06.12 Perforated NEC Heartlands BCH PICU IMV On 19.06.12 06:35 07:55 08:25 8 09:00 4 10:05 10:25 3hrs 50minsBaby being intubated at the time of first call,handed over to day team

30.06.12 Gastroschisis Shrewsbury Alder Hey PICU SVIA 00:22 01:25 01:25 00:30* 52 01:30 70 03:40 05:15 4hrs 53mins*Team already on site for another transfer, hencetime team left base prior to time call received

19.07.12 Gastroschisis B'ham Women's BCH NNSU SVIA 20:20 21:15 21:15 21:20 0 21:35 4 22:20 22:40 2hrs 20mins

21.07.12 Gastroschisis Heartlands BCH PICU IMV 09:47 10:05 10:10 10:30 8 10:55 4 12:45 13:05 3hrs 18minsBaby not ready and awaited confirmation ofPICU cot

29.07.12 Perforated NEC City Dudley Rd BCH PICU IMVOn

05.06.12 14:00 14:15 14:30 4 14:45 3 16:25 16:45 2hrs 45minsBaby hypothermic due to need for emergency abdo drain insertion. Very unstable baby. RIP 29/07/2012

nothing for August

05.09.12 Perforated NEC Heartlands BCH PICU IMVOn

31.08.12 19:20 19:20 20:25 8 20:45 3 22:40 23:10 3hrs 50mins 13.09.12 Gastroschisis B'ham Women's BCH NNSU SVIA 11:15 12:00 12:00 12:00 0 12:00 4 12:50 13:20 2hrs 5 mins

09.10.12 ?Perforated NEC New Cross BCH PICU IMVOn

06.09.12 12:15 12:15 12:40 16 13:30 16 15:00 15:30 3hrs 15mins 16.10.12 Gastroschisis Walsall Manor BCH NNSU SV 02 17:19 17:00 17:00 17:00 24 17:45 12 19:25 19:50 2hrs 31mins Team diverted from Heartlands transfer 01.11.12 TOF Walsall Manor BCH PICU IMV 00:45 10:10 10:15 10:55 13 11:40 12 13:15 14:00 13hrs 15mins Call not received by NTS until 1010hrs

17.11.12 Gastroschisis B'ham Women's BCH NNSU SVA 00:25 01:10 01:10 02:20 0 02:20 4 03:00 03:30 3hrs 5mins

Call received during on call hours, staffcame in from home (1 hour approximately to travel to workplace from home)

18.11.12 ?Perforated NEC New Cross BCH PICU IMV/NO On 14.11.12 23:40 23:50 00:40 16 01:15 16 02:40 03:30 6hrs 24mins

Call received during on call hours, staffcame in from home (1 hour approximately to travel to workplace from home)

22.11.12?TOF - duodenal atresia Heartlands BCH PICU IMV 07:00 13:30 13:30 14:30 8 15:05 3 16:55 18:00 11hrs Bed not available on PICU until 1600hrs

24.12.12 Gastroschisis B'ham Women's BCH NNSU Inc02 13:37 14:45 14:45 14:45 0 14:45 4 16:00 16:30 2hrs 55mins WMNTS not contacted immediately

02.01.13 Gastroschisis B'ham Women's BCH PICU IMV 05:02 05:45 05:45 06:40 0 06:45 4 09:00 09:20 3hrs 18mins

Call received during on call hours, staff came in from home but baby intubated and required PICU bed, handed over to day team whilst awaiting confirmation of bed

07.01.13 Gastroschisis B'ham Women's BCH NNSW NP02 18:05 19:20 19:20 19:30 0 19:30 4 20:20 20:40 2hrs 35 mins

22.01.13 Perforated NEC Shrewsbury Liverpool IMV unknown 13:10 13:10 14:45 52 15:25 69 16:30 18:30 5hrs 20 mins Time recorded from when call received as time baby born not available

01.02.13 ?Perforation B'ham Women's BCH PICU IMVOn

28.01.13 12:25 12:25 12:25 0 12:30 4 15:25 15:55 3hrs 30mins Baby not ready, required intubation and x-ray

05.02.13 ?Perforated NEC Heartlands BCH PICU IMVOn

04.01.13 04:40 04:40 05:45 8 06:05 3 08:10 08:25 3hrs 45 mins Call received during on call hours

15.02.13 Gastroschsis New Cross BCH PICU SIMV 12:48 13:20 13:20 13:45 16 14:40 16 16:00 16:40 3hrs 52mins Bed not confirmed at time of referral (confirmed at 13:45)

20.02.13 Intestinal perforation UHNS Alder Hey PICU IMVOn

16.02.13 16:00 16:10 16:35 54 18:00 55 19:30 20:45 4hrs 45mins Delay at Alder Hey waiting for baby to go into theatre

27.03.13 Gastroschisis B'ham Women's BCH NNSU SVIA 10:17 11:40 11:45 12:40 0 12:50 4 13:50 14:05 3hrs 48minsDelay due to baby not yet fully admitted to NNU and no discharge paperwork available

28.03.13 ?Intestinal perforation Walsgrave BCH PICU IMV On 16.03.13 15:20 15:30 15:45 30 16:20 26 17:55 18:55 3hrs 35mins Performing transfer on behalf of CenTre team


Types of Time Critical Transfers

NEC Gastrochisis TOF0

2

4

6

8

10

12

1413

14

2

No CHD not responding to prostaglandin infusion (4) ; No (5) recorded


Meeting standards for time critical transfers

WMNTS dispatch times for all TCT=31 mins (0-95 mins)(n=28)(20 mins if on-call /bed availability etc excluded (n=21))

WMNTS dispatch times for TCT LNU –18 mins (n=3)SCU - 0

Use appropriate neighbouring team if standard cannot be met – KIDS, CenTre (1 performed by KIDS; WMNTS performed 1 for CenTre)


Dispatch <1 hour

22

2

2 21

achievedbed not availableshift changeon callteam factors

1 transfer performed for CenTre; 1 transfer performed by KIDS as WMNTS oncall

Geographical Area Covered


Travelling times from Base Hospital

Time (mins)

City 18

BCH 19

BHH 24

Russells Hall

26

Redditch 28

Walsall 30

Time (mins)

Good Hope 31

Worcester 34

New Cross 36

Stafford 54

UHNS 67

Hereford 70

Shrewsbury 74

Transfer numbers

Refusals

Data collection

Types of Transfers


Staffing

Clinical Incidents

Budget

Changes


Staffing

Funding Actual

Consultant 1.3 (0.9, 0.2, 0.3) 1.2

Nurse Consultant (8c) 1 1

ANNP (mid point 8b) 8 3 + 1 secondment ( + 0.5 8a)

ST6 0 Approx 0.5

Band 6 nurses 8 5.0 (3 vacancies advertised)

Band 4 1 1

Band 2 (cot locator) 1 1

Transfer numbers

Refusals

Data collection

Types of Transfers


Staffing

Clinical Incidents

Budget

Changes


Clinical Incidents

17%

1%

11%

4%

30%

14%

2%

19%

2%

Temperature

Staff shortages

Clinical

NTS incidents

Communication

Ambulance

Staff accident

Equipment

Care Withdrawn


Comparison of Incidents

2012/13 2011/12 2010/11 2009/10 2008/090

200

400

600

800

1000

1200

1400

1600

1180

1074

1253

1422

1269

81 73119 113

760.07 0.07 0.08 0.08 0.06

Number of transfers performed Number of incidents reported % incidents vs number of transfers

Types of Incidents

2008/09 2009/10 2010/11 2011/12 2012/130

5

10

15

20

25

30

35

22

2019

26

30

8

18

16

30

19 Temperature

Clinical

Communication

Ambulance

Equipment

Transfer numbers

Refusals

Data collection

Types of Transfers


Staffing

Clinical Incidents

Budget

Changes

Pay Non pay£0.00

£200,000.00

£400,000.00

£600,000.00

£800,000.00

£1,000,000.00

£1,200,000.00

Budget

Actual

Budget

Transfer numbers

Refusals

Data collection

Types of Transfers


Staffing

Clinical Incident

Budget

Changes


Developments over the last 6 months


Changes to Working Practice

Team now on site at night tues- thurs – allows overnight planned back transfers

Rotational post between BWH & WMNTS commencing

Succession planning with 2 student ANNPs


Ambulance Driver Training


New Ambulances


Parents Travelling with Babies


Tecotherm Mattress & Trolley


WMNTS Objectives 2013-14

Objective 1: To meet Continuing Professional Development requirements in neonatal transport

Reference Network Objectives

Work Programme Measurement Used Lead Review DateProgress Review

April 2014

SSBCNN Objective 3 SWMNN Objective 4 Toolkit 5

Continue to provide training on Transfer medicine to multi-professional staff in the networks

Attendance record at bi-annual study days, ST Deanery training programme, QIS programme

Alex Philpott Jackie Harrison

On going

To provide outreach programs for Units in the networks

Service delivery, supporting network study days, training packages on web site


On going

To ensure educational needs for WMNTS staff pertaining to neonatal transport are met

Rolling programme for all WMNTS staff to complete accredited transport course


On going

Bespoke training to WMAS prehospital neonatal providers

Bespoke training delivered to support regional MLUs/paramedics

Alex Philpott Apr-14

Objective 2: Promote the activities and share the experiences of the NTS with others



April 2014

SSBCNN Objective 1 SWMNN Objective 1, 2 Toolkit 7.8 + 7.12

Quarterly data to include risk assessment / Near Miss

Report to be generated to each unit and Network Board

Jackie Harrison Q3,4,1,2

Minimise the number of out of region transfers in particular for surgical management


Jackie Harrison Q3,4,1,2

Monitor and audit babies transferred for cooling


Q3,4,1,2

Present data to Transfer User Group

Jackie Harrison June 13, Jan 14

Education workstream to be trained in simulation medicine

Record of completion of training for 3 team members; record of participation in network simulations

Alex Philpott June 13, Jan 14

Monitor and audit time critical transfers

Present data to Transfer User Group

Jackie Harrison June 13, Jan 14

Objective 3: To deliver a safe transport service which meets the needs of neonatal services in the West Midlands



April 2014

SSBCNN Objective 2, 3 SWMNN Objective 6

Continue to support units initiate therapeutic hypothermia

Service delivery Attendance record

Jackie Harrison/ WMNTS Cooling lead

Dec-13

To perform user satisfaction questionnaire

Audit presented at Transfer User Group


June 13, Jan 14

Training in use of Tecother Mattress and transport device

WMNTS Training record Alex Philpott Jackie Harrison

Jun-13

To provide a transport service for neonatal palliative care referrals

Record kept of palliative care transfers


Apr-14

Objective 4: To ensure the NTS is appropriately resourced for all neonatal transport activity



April 2014

SSBCNN Objective 3 SWMNN Objective 2

24 hour dedicated call handling centre

Option appraisal for establishment of call handling centre completed


Dec-13

Toolkit 4.5

Ensure an adequate number of appropriately trained personnel for NTS by support of student ANNPs and rotation into neonatal units

Monitor staffing levels; Alex Philpott Ongoing

Supporting ST Training during rotation into NTS

ST training programme and feedback from ST

Alex Philpott

Ongoing


Terms of Reference

TERMS OF REFERENCE OF THE WEST MIDLANDS TRANSFER USER GROUP (wmTUG)

The group is responsible for:

– Monitoring the effectiveness of the West Midlands Neonatal Transfer Service (WMNTS)

– Identifying transfer issues and future transport requirements within the Networks

– Identifying investment required to achieve a robust transfer service for the Networks

– Making recommendations to the Network Boards to improve transport collectively within the Operational

Delivery Networks (ODN) in line with the recommendations in the Review of Neonatal Intensive Care

Services and the Toolkit for High Quality Neonatal Services

– Implement, review and further develop transfer guideline, protocols and procedures for use across the

Networks

– Make recommendations for standardising transport education and training across the Networks

– Continue to contribute to regional and national discussions relating to developments in neonatal transfers

ACCOUNTABILITY, RESPONSIBILITIES AND PERFORMANCE MANAGEMENT

– The members of the Transfer Group will be accountable to the ODN Boards and are responsible for

providing progress reports to the boards.

– Chair to be rotated between the Transport Consultant Leads, in their absence Transport Nurse Consultant

to chair

– The Chair of the group will be accountable to the 2 ODN Boards for the effective performance of the group.

MEMBERSHIP

– WMNTS team members

– One neonatal medical/nurse representative from each provider Trust

and deputy

– One obstetric/midwifery representative from each provider Trust and

deputy

– A representative from Patient First Ambulance Service

– Network Managers

– Network Practice Educators

– WMNTS Administrator (minute taker)

– Parent user

– SCN/ senate members

– Member of NHS commissioning body

MEETINGS AND PROCEDURES

– The group shall hold meetings as necessary, however unless agreed otherwise, meetings should be held

twice a year. Venue will be rotated between the two networks where possible.

– All meetings shall be arranged and serviced by the WMNTS Administrator hosting the meeting

– Group members will receive written notice of the meeting in the form of a copy of the agenda and relevant

papers, which will be circulated at least 5 working days in advance of the meeting.

– Special meetings may be called as necessary by either the Chair or at least 2 members of the group from

each of the network if it is determined that there are urgent matters to be considered. In such circumstances

the written notice of the meeting may not be less than the prescribed 3 working days.

– Meetings of the Transfer User Group will be deemed quorate if there is 4 representatives from each of the

Networks – if response suggests that the meeting will not be quorate the lead transport consultant/ nurse

consultant may decide to cancel the meeting at short notice unless there are any issues requiring urgent

action

– Every question to be decided at a meeting shall be determined by the majority of votes of members present.

Where there is equal division of votes, the chair shall have a casting vote.

– No matter which the group has agreed may be rescinded or varied at a subsequent meeting unless that

rescission or variation is a specific item of business on the agenda for that meeting.

– Deputies will be encouraged.

– Regular reports and updates on progress made to the ODN Board


National Transport Group Conference 2013

Friday 29th November 2013Burlington Hotel Birmingham B2 4JQProgramme of Events

• Welcome• Chairman’s report• The Challenges of Neonates for a Paediatric Intensive Care Retrieval Service• The Australian Transport Service• The Parent’s Perspective• Guest Speaker • Poster Presentations• Close

Hosted by:

AbstractsAuthors are invited to submit audit or research abstracts to [email protected] (see separate application form)

Abstracts can be original research, development of a new guideline or audit. All must have relevance to neonatal transport medicine.Abstracts should state briefly and clearly the purpose, methods, results and conclusions of the work with a maximum word count of 350 words.

Deadline for submission is 30th September 2013

Accepted admissions to be notified by 18th October 2013PricesDelegate rate £100 - day conference fee and dinner

Special team rate £500 - day conference fee and dinner for 5 people + 1 person freeFurther information relating to accommodation, location and local amenities on

separate flyer

mailto:[email protected]


Cooling ActivityApril 2012 ~ March 2013

April May June July Aug Sept Oct Nov Dec Jan Feb Mar0

1

2

3

4

5

6

7

RequestsTransfersRefusal/Cancellation


Requests from

BWH

City

Good Hope

Linco

ln

New X

Redditc

h

Russells

Hall

Stafford

Wals

all

Warw

ick

Worce

ster

Hereford

0

2

4

6

8

10

12


Transfers requests Per network

CNN

SSBCNN

SMWNN

17

32

2


Transfer To

New Cross Heartlands UHNS BWH0

5

10

15

20

25


17

• 14

Transfers performed To each network

• 50% of babies were admitted to SSBCNN for therapeutic hypothermia

• 50% of babies were admitted to SWMNN for therapeutic hypothermia


Transfers performedReferral age

Within 1 hour

Within 2 hours

Within 3 hours

Within 4 hours

Within 5 hours

Within 6 hours

Greater than 6 hours

0

2

4

6

8

10

12

14

16

18

20

Number of babies


Transfers performedResponse time (Call → Arrival on Ref. NNU)

Within 1 hour

Within 2 hours

Within 3 hours

Within 4 hours

Within 5 hours

Within 6 hours


0

5

10

15

20

25

30

Number of transfers


Transfers performedAge at Cooling centre

Within 5 hours

Within 6 hours

Within 7 hours

Within 8 hours

Within 9 hours

Within 10 hours

Within 11 hours

Within 12 hours


0

2

4

6

8

10

12

14

Number of babies


Transfers performedAge 33-34°C Achieved

Within 1 hour

Within 2 hours

Within 3 hours

Within 4 hours

Within 5 hours

Within 6 hours


0

2

4

6

8

10

12

14

16

Number of babies


Transfers performedMethods of cooling

Active – inactivated transwarmer

Active – cool water gloves

Passive

0 5 10 15 20 25 30 35


Transfers performedBabies not cooled

< 33°C

> 34°C

0 1 2 3 4 5 6 7 8 9

Number of babies


Transfers performedVentilatory support

Ventilated Ventilated + Nitric Oxide CPAP SVIA0

5

10

15

20

25

30

35

40

45

50


Transfers performedParalysis & sedation

Morphine Morphine + Paralysis Nil0

5

10

15

20

25

30

35

40


Transfers performedPhenobarbitone use

Phenobarb Loading Dose Phenobarb Loading + Maintenance Nil0

5

10

15

20

25

30


Transfers performedInotropic support

Dopamine

Dobutamine

Dopamine + Dobutamine

Nil

0 5 10 15 20 25 30 35 40

west midlands neonatal transfer service wmnts activity april 2012-march 2013

Documents

transfer slide

completion of transfer

hours1 slide

transfers attributable

old time critical transfers

new time critical transfers

retrieval service

neonatal units