Acute Referral Process

Inform parents that the transfer needs to take place

Telephone the Cot Bureau on 0300 330 9299, request the transfer and provide the required details in table 1 below

Ensure that medical and nursing letters are completed, blood results, gas charts etc. are photocopied and all x-rays are available

Ensure Badger has been updated and baby has been discharged from the system

The Cot Bureau will contact the appropriate neonatal unit in order of proximity to the referring hospital. The Cot Bureau will contact the referring neonatal unit with appropriate details

The Connect NW transport ANNP or Consultant covering will contact the referring unit, take the clinical history and offer immediate management advice. For this call the information you may get asked is outlined in table 2. Please have this information readily available with copies of the notes, charts and results to hand

On some occasions this information may be requested during a conference call (surgical, cardiac or other complex cases).  Normally the referring clinician will be asked to provide a concise summary of the case, and following this specific further information may be requested by the transport staff or other receiving unit specialists

Connect NW will call for an ambulance and depart as soon as it arrives

Connect NW will help stabilise the baby if required and get the baby ready for transfer to receiving unit, however, stabilisation measures should be initiated where possible prior to this point

Ensure any EBM is ready to be collected prior to departure

Connect NW will contact the receiving unit prior to departure and if possible will aim to speak to parents prior to departure

When you contact Cot bureau for a postnatal acute referral they will ask the information listed below in Table 1.  Please indicate at the outset if this is for advice only or the baby is anticipated to require a transfer.

Details required for referral (Table 1)

  • Name of referring clinician and job title
  • Referring hospital and contact number
  • Baby’s name
  • Baby’s local hospital number, Badger ID and NHS number
  • Baby’s date of birth and time of birth
  • Baby’s gestation at birth and current corrected gestation
  • Baby’s birth weight and baby’s current weight
  • Parents address and postcode
  • The type of care the baby will require (Intensive / High dependency / Special)
  • A brief summary of the baby’s current condition and reason for requesting a transfer

Emergency Referral Sheet (Table 2)

  • Demographic details as given to cot bureau (box 1 of flow chart)
    Perinatal details
  • Perinatal history, mode of delivery, condition at birth, Apgar’s, Cord gases, Resuscitation details
  • Mode of ventilation and current settings, recent changes and blood gases, ET size, length and position.  X-ray findings and other management, including surfactant.
  • Summary of CVS problems, ECHO findings, Blood pressure, capillary time, CVS drug infusions
    Fluids and Nutrition
  • Total fluid volume, Enteral/ IV fluid ml/hr, Type of fluids, NGT/ OGT in place and what size tube and how many cm’s is the tube at, any aspirates/ description of aspirates, what is baby’s urine output, When were bowels last opened, stool appearance, summary of any issues with feeding, any issues with electrolytes, any abdominal imaging taken.
    Neurological problems
  • Summary of CNS problems and treatment that has been given, does the baby fit Toby Cooling criteria, passive/ active cooling started?, conscious level, any seizure activity, moro and suck reflexes normal?, CFM started?, CrUSS taken
    Signs/ symptoms of sepsis
  • Summary of sepsis concerns, CRP/ blood culture results, have IVAB started.
  • Summary of genetic issues, genetic tests taken? Summary of any social issues with family, safeguarding notes available?
    Lines drugs and infusions
  • What access does baby have, UVC/ UAC tip position, have lines been confirmed on x-ray?, Any lab results, Has baby ever required a blood transfusion and when was this, What drug infusions is baby requiring, what drug therapy is baby required