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Letters
Categorising neonatal transports
  1. Andrew Leslie1,
  2. Alan Fenton2
  1. 1CenTre Neonatal Transport, University Hospitals of Leicester, Leicester, UK
  2. 2Newcastle Neonatal Service, Newcastle upon Tyne, UK
  1. Correspondence to Andrew Leslie, CenTre Neonatal Transport, University Hospitals of Leicester, Leicester LE1 5WW, UK; andrew.leslie{at}uhl-tr.nhs.uk

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The UK is now covered by separately commissioned neonatal transport services. This has required significant investment and it is essential that meaningful comparisons of activity levels, outcomes and value for money be made.

The UK Neonatal Transport Interest Group devised a dataset in 2005 to compare transport teams. The major problem encountered was defining mutually exclusive categories of transfer. The terms ‘planned’ and ‘unplanned’ were agreed, with ‘time-critical’ added following publication of the Neonatal Toolkit.1 Unplanned/time-critical transfers are subject to scrutiny as part of the Neonatal Quality Standards.2 There is a wide variation between teams in the proportion of transfers that are classified as ‘unplanned’. In 2010, this ranged between teams from 23% of transfers to 63%.

Is this apparent disparity between teams due to a classification issue? We sent a questionnaire to transport service leads in the UK in December 2010, comprising 10 hypothetical transport scenarios. Respondents had to categorise each as planned, unplanned or time-critical.

Twenty-four responses were received from 13 neonatal transport services. Four services returned more than one response. All data were analysed to examine intraservice and interservice differences.

In none of the hypothetical cases was there complete agreement across all respondents regarding how the transfer should be categorised. There was poor agreement regarding whether to classify a transfer as planned or unplanned, with eight of the ten scenarios having some respondents who placed the transfer in each of these categories.

Where individual transport services submitted more than one response, none showed congruent responses within service. Service one showed agreement on 4/10 responses, service two on 3/10, service three on 6/10 and service four on 3/10.

Conclusion

These data demonstrate that transfers are categorised inconsistently both within and between transport services.

Discussion

Previously, it was convenient to divide transport activity into simple categories such as ‘back transfer’ and ‘acute transfer’. These have become obsolete as discrete identifiers over time as teams transfer infants for investigations or to manage networks' capacity or for other reasons. Unambiguous and mutually exclusive categories are needed.

The Neonatal Toolkit offered no definition of ‘time-critical’ as a category and there is ambiguity in the responses we received. An example where delay in transfer might have serious clinical consequences (“26/40 infant aged 7 days in level 2 centre; develops acute abdo distension and is found to have a pneumoperitoneum. Transfer to level 3 (surgical) centre requested.”) was categorised by five respondents as ‘unplanned’ only.

Further work by the neonatal transport community is required to both agree categories and ensure that implementation locally is standardised so that workload and quality of teams may be compared and national quality standards are meaningful.

Acknowledgments

The authors thank the members of UK Neonatal Transport Interest Group who contributed by responding to the questionnaire.

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Footnotes

  • Competing interests None.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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