NTG Annual Transport Data. 2019. -...

NTG Annual Transport Data.

2019.

Colin Devon (data analyst) and

Allan Jackson (consultant

neonatologist)

ScotSTAR

Method

• Email to transport service’s medical and

nursing leads requesting activity data from

1.1.19 to 30.6.19

• Brief additional information about each

service.

Reorganisations &

additions for 2019 data

• No reorganisations in 2019

• 1 service new to the data submission-

Jersey

Number of services, UK

• 2012 – data from 22

• 2013 – data from 21

• 2014 – data from 19

• 2015 – data from 19

• 2016 – data from 18

• 2017 – data from 18

• 2018 – data from 15

• 2019- data from 16 (1 new)

32%

UK summary data,

Jan-Jun/year,

all transfers, all teams (n=)

7152

7562

7892 7997

7910 7938

7594

7773

6000

6500

7000

7500

8000

8500

2012 2013 2014 2015 2016 2017 2018 2019

2013 2014

2015 2016 2017 2018 2019

Total

transfers

7562 7892 7997 7910 7938

7594 7773

Ventilated 1961

(26%)

1949

(25%)

2155

(27%)

2000

(25%)

1913

(24%)

1939

(26%)

1871

(24%)

HFOV - - 16 (<1%) 16 (<1%) 39 (2%) 48 (2%) 54 (3%)

CPAP 906(12%) 819 (10%) 790 (10%) 737 (9%) 621 (8%) 529 (7%)

High-flow

- - 452 (6%) 496 (6%) 674 (9%) 767 (10%)

Cooling 288 (4%) 249 (3%) 274 (3%) 288 (4%) 245 (3%) 255 (3%) 281 (4%)

iNO 111 (1%) 117 (1%) 138 (2%) 145 (2%) 154 (2%) 157 (2%)

Palliative 9 (<1%) 19 33 33 20 24

UK summary data

Jan-Jun/year

Total Transfers/team, Jan-Jun 2019

649

250

466

934

731

805

687

617

79

249

442

321

789

539

207

8 0

100

200

300

400

500

600

700

800

900

1000

ScotSTAR NISTAR NNeTS Connect NW

Embrace CenTre W Mids NTS ANTS N Wales NTS

CHANTS SONET NEST London NTS KSS Peninsula Jersey GH

Changes in activity by

team, 2018 v 2019

7.5%

30.2%

17.4%

8.3% 8.0%

21.5%

11.2%

2.3%

27.8%

2.5%

7.9%

2.1%

14.2%

4.7%

4.8%

-20%

-15%

-10%

-5%

0%

5%

10%

15%

20%

25%

30%

35%

ScotSTAR NISTAR NNeTS Connect

NW

Embrace CenTre W Mids

NTS

ANTS N Wales

NTS

CHANTS SONET NEST London

NTS

KSS Peninsula

Number of ventilated transfers,

Jan-Jun 2014-2019

0

50

100

150

200

250

300

350

400



CHANTS SONET NEST London NTS KSS Peninsula Jersey GH

2014 2015 2016 2017 2018 2019

HFO capability and activity • 2 teams in 2015

• 5 teams in 2016

• 6 teams in 2017

• 8 teams in 2018 and 2019

Teams with HFO HFO in transit HFO commenced by NTS HFO commenced

by NTS %

ScotSTAR 5 0 0%

Connect NW 11 3 27%

W Mids NTS 0 0 N/A

CHANTS 0 0 N/A

NEST 3 3 100%

SONET 6 4 67%

London NTS 29 17 59%

This is the first year that data on initiation of HFOV has been

collected

Response standards

Data on

– Time critical % mobile in 60 mins

– Referral response time for ICU/uplift transfers-

3.5 hours

– Uplift transfers within catchment are

performed be commissioned team(%)

Number of time-critical

transfers/team, Jan-Jun 2015-2019

0

10

20

30

40

50

60

70

80

90

100

ScotSTAR NISTAR NNeTS Connect NW Embrace CenTre W Mids NTS ANTS N Wales NTS CHANTS SONET NEST London NTS KSS Peninsula

2015 2016 2017 2018 2019

Note that this does not represent the total emergency workload of

the teams, the NTG team critical benchmark uses specific case

definitions to assess response times

TC transfers/team as % of uplift

transfers, Jan-Jun 2015 - 2019 2015 2016 2017 2018 2019

TC 469 408 341 315 265

Uplift 3172 3355 3729 3718 3839

% 15% 12% 9% 8% 7%

0%

10%

20%

30%

40%

50%

60%

70%

Scotstar NISTAR NNeTS Connect NW Embrace CenTre W Mids NTS ANTS N Wales NTS CHANTS SoNET NEST London NTS KSS Peninsula

2015 2016 2017 2018 2019

% of time critical transfers team

mobile within 60 minutes of start of referring call.

2014 2015 2016 2017 2018 2019

% Met 77% 81% 84% 82% 79% 80%

Total

(=n) 409 469 408 341 315 265

Without the outlier out in this years’ numbers (see next slide) target was

met on 87% of occassions

% of time critical transfers team

mobile within 60 minutes of start of referring call.

0%

25%

50%

75%

100%


2014 2015 2016 2017 2018 2019

Team arrived with the patient within 3.5 hours

of the start of the referring call (Intensive care; uplift) (%), Jan-Jun/year.

2013 2014 2015 2016 2017 2018 2019

% Met 72% 86% 83% 82% 80% 85% 82%

Total

(=n) 1689 1836 1945 1787 2031 1800 1953

Team arrived with the patient within 3.5 hours

of the start of the referring call (Intensive care; uplift) (%), Jan-Jun/year.

0%

25%

50%

75%

100%


2014 2015 2016 2017 2018 2019

Stabilising time (minutes),

Jan-Jun 2019, Median (25th & 75th centiles), uplift/ICU transfers.

The red line indicates the mean stabilising team for all teams

Neonatal Transport Services transfer

at least 95% of patients requiring transfer for uplift

within its defined catchment area. (%)

Year 2013 2014 2015 2016 2017 2018 2019

n = 3109 3416 3268 3355 3729 3718 3839

Transfer by Commissioned Team n = 2704 3097 3172 2971 3543 3637 3719

(87%) (90.7%) (97.1%) (88.6%) (95%) (97.8%) (96.9%)

Previous 3 year average 94%

Neonatal Transport Services transfer

at least 95% of patients requiring transfer for uplift

within its defined catchment area. (%)

0%

25%

50%

75%

100%



CHANTS SONET NEST London NTS KSS Peninsula

2013 2014 2015 2016 2017 2018 2019

Number transferred on iNO

Jan-Jun/year

2013 2014 2015 2016 2017 2018 2019

iNO for UK 111 117 138 145 - 154 157

0

5

10

15

20

25

30

35

40

45

50


2013 2014 2015 2016 2017 2018 2019

% transferred on iNO

Jan-Jun/year

0%

1%

2%

3%

4%

5%

6%


2013 2014 2015 2016 2017 2018 2019

iNO use by team,

gestation breakdown 2019

13

0

11

16

8

10

18

10

0

3

14

6

34

11

3

0

10

20

30

40


Embrace CenTre W Mids NTS

ANTS N Wales NTS

CHANTS SONET NEST London NTS

KSS Peninsula

iNO <28 wks iNO 28-35 wks iNO >35wks

iNO use by team,

gestation breakdown 2019

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%



ANTS N Wales NTS


KSS Peninsula

iNO <28 wks iNO 28-35 wks iNO >35wks

iNO started by team,

Jan-Jun 2019

31%

0%

73%

56%

100% 100%

50%

100%

0%

100%

71%

100% 100% 100%

67%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%



ANTS N Wales NTS


KSS Peninsula

2019 n= 13 0 11 16 8 10 18 10 0 3 14 6 34 11 3

Active vs. passive cooling,

number of teams, 2014 - 2019.

13

15

15

15

14

14

0 5 10 15 20

2014

2015

2016

2017

2018

2019

Active Cooling Teams

6

4

3

3

1

2

0 5 10 15 20

2014

2015

2016

2017

2018

2019

Passive Cooling Teams

Passive cooling in transit over time: 2014 – 2019, Jan-Jun

9

5 5

2

18

3 2

1 0

5

10

15

20

2014 2015 2016 2017 2018 2019

Passive Journeys

Passive Journeys by Active Team Passive Journeys by Passive Only Team

Number transferred for cooling or

assessment for cooling by team, Jan-Jun 2019

9

0

12

30

18 20 20

30

1

4

20

35

45

27

10

0

5

10

15

20

25

30

35

40

45

50



ANTS N Wales NTS


KSS Peninsula

Active n= Passive n =


assessment for cooling by team, Jan-Jun 2019-

active/passive detail

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%



ANTS N Wales NTS


KSS Peninsula

Active % Passive %


assessment for cooling, Jan-Jun 2013 - 2019 Year 2013 2014 2015 2016 2017 2018 2019

UK total 288 249 274 288 245 255 281

0

10

20

30

40

50

60

70

80


2013 2014 2015 2016 2017 2018 2019

Transferred for cooling,

temp 33-340C at 6 hours of age.

Year 2016 2017 2018 2019

Cooling n= 288 245 255 281

Transferred on active cooling n= (%)

277 229 250 279

(96.2%) (93.5%) (98%) (99.3%)

Infant temperature data available n= (%)

216 191 230 267

(75%) (78%) (90.2%) (95%)

Temp 33-340C at 6hrs n= (%)

180 154 182 214

(62.5%) (62.9%) (71.4%) (76.2%)

Infants transferred for cooling,

percentage in target range at 6 hours of age by

service, Jan-Jun 2019

2019 n= 9 0 12 30 18 20 20 30 1 4 20 35 45 27 10

78%

0%

100%

66%

100%

90% 90%

79%

100% 100%

75%

80%

71%

81%

56%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%


Infants transferred for cooling,

percentage in target range at 6 hours of age by

service, Jan-Jun/year.

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%



ANTS N Wales NTS


KSS Peninsula

2016 2017 2018 2019

Age (mins) target temperature achieved,

infants transferred for cooling, Jan-Jun 2019 (median,

range)

0

60

120

180

240

300

360

420

480

540

600

660

720

780

840

900

960



ANTS N Wales NTS


KSS Peninsula

The green line indicates the target time of 6 hours.

On further enquiry it is clear that the longer times to target

temperature relate to timing of initiation of cooling in referring

centres

Hypocarbia Jan-Jun/year, infants on a

ventilator during journey, cooling transfers, national data

Jan-Jun 2015-2019

Year 2014 2015 2016 2017 2018 2019

Cooling n = 249 274 288 245 255 281

Cooling & Ventilated, n= (%)

202 230 217 190 195 203

(81.1%) (83.9%) (75.3%) (77.6%) (76.5%) (72.2%)

pCO2 <4kPa, n= (%)

27 25

21

15

19

19

(13.4%) (10.9%) (9.7%) (7.9%) (9.7%) (9.4%)

Hypocarbia in infants

transferred for cooling: pPO2<4 at end of

transfer by service, Jan-Jun 2015-2019

0%

10%

20%

30%

40%

50%

60%


2015 2016 2017 2018 2019

Hypocarbia & hypercarbia

- pCO2 <4 kPa

- pCO2 >7 kPa and pH<7.2

…on the gas measurement on completion of

transfer of ventilated infants.

Note that not all infants had pCO2 available post-

transfer.

Hypocarbia & hypercarbia,

Jan-Jun/year, infants on a ventilator during journey, all

operational reasons.

Year 2013 2014 2015 2016 2017 2018 2019

Ventilated + Gas n = 1355 1895 1685 1493 1519 1524 1459

pCO2 <4kPa, n= (%)

118 106 122 107 100 94 86

(8.7%) (5.6%) (7.2%) (7.2%) (6.6%) (6.2%) (5.9%)

pCO2>7kPa & pH<7.2, n= (%)

68 94 79 83 73 65

(3.6%) (5.6%) (5.3%) (5.5%) (4.8%) (4.5%)

% pCO2 <4 kPa on completion,

by service. Jan-Jun 2019

0.0%

4.0%

3.0% 3.0%

4.5%

8.5%

0.0%

2.6%

0.0%

4.9%

6.0% 5.7%

9.7%

8.5% 8.9%

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%


Red line displays mean of teams

% pCO2 <4 kPa on completion,

by service. Jan-Jun 2013-19

0%

5%

10%

15%

20%

25%


2013 2014 2015 2016 2017 2018 2019

% pCO2 >7kPa & pH<7.2 on

completion , per service, Jan-Jun 2019

0.0%

8.0%

5.0% 5.2%

7.5%

1.2%

15.4%

3.2%

0.0%

2.4%

3.6% 4.1% 4.2%

7.6%

0.0% 0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

14.0%

16.0%

18.0%



% pCO2 >7kPa & pH<7.2 on

completion , per service, Jan-Jun 2014-19.

0%

5%

10%

15%

20%

25%


2014 2015 2016 2017 2018 2019

% pCO2 >7kPa & pH<7.2 and/or

pCO2 <4 kPa on completion , per service,

Jan-Jun 2019

0.0%

11.8%

8.0% 8.2%

11.9%

9.7%

15.4%

5.8%

0.0%

7.3%

9.5% 9.8%

13.9%

16.1%

8.9%

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%



% pCO2 >7kPa & pH<7.2 and/or

pCO2 <4 kPa on completion , per service,

Jan-Jun 2015-19

0%

5%

10%

15%

20%

25%



ANTS N Wales NTS


KSS Peninsula

2015 2016 2017 2018 2019

Operational reason for transfer

for premature infants transferred on the first 3 days

of life: Uplift

0

100

200

300

400

500

600

700

800

2014 2015 2016 2017 2018 2019

23+0 to 26+6 27+0 to 31+6 32+0 to 35+6



of life: Capacity

0

20

40

60

80

100

120

140

160

180

200

2014 2015 2016 2017 2018 2019

23+0 to 26+6 27+0 to 31+6 32+0 to 35+6



of life, Repatriation

0

20

40

60

80

100

120

140

160

180

200

2014 2015 2016 2017 2018 2019

23+0 to 26+6 27+0 to 31+6 32+0 to 35+6

Uplift transfers, 1st 3 days

of life, 23-32 week infants, Jan-Jun

2019

0

5

10

15

20

25

30

35

40

45




23-26+6 Uplift 27-31+6 Uplift

Capacity transfers, 1st 3 days of

life, 23-31+6 week infants, Jan-Jun 2019

0

2

4

6

8

10

12

14

16

18




23-26+6 capacity 27-31+6 capacity

Capacity transfers, 1st 3 days

of life, 27-31+6 week infants,

Jan-Jun 2015 - 2019

0

5

10

15

20

25

30

35

40

45

50


2015 2016 2017 2018 2019

Premature Newborn Infants

23 to 32 weeks Temperature Tally, Jan-Jun 2019



ANTS N Wales NTS


KSS Peninsula 0

10

20

30

40

50

60

70

80

90

1st assess 23-32 <36.5

1st assess 23-32 36.5-37.5

1st assess 23-32 >37.5

2nd assess 23-32 <36.5

2nd assess 23-32 36.5-37.5

2nd assess 23-32 >37.5


23 to 32 weeks Temperature Tally, Jan-Jun 2019



ANTS N Wales NTS


KSS Peninsula 0%

25%

50%

75%

100%

1st assess 23-32 <36.5

1st assess 23-32 36.5-37.5

1st assess 23-32 >37.5

2nd assess 23-32 <36.5

2nd assess 23-32 36.5-37.5

2nd assess 23-32 >37.5

Premature Newborn Infants 23 to 26+6

weeks Temperature Tally, Jan-Jun 2019



ANTS N Wales NTS


KSS Peninsula 0

5

10

15

20

25

30

35

40

45

1st assess 23-27 <36.5

1st assess 23-27 36.5-37.5

1st assess 23-27 >37.5

2nd assess 23-27 <36.5

2nd assess 23-27 36.5-37.5

2nd assess 23-27 >37.5


23 to 26+6 weeks Temperature Tally, Jan-Jun 2019



ANTS N Wales NTS


KSS Peninsula 0%

25%

50%

75%

100%

1st assess 23-27 <36.5

1st assess 23-27 36.5-37.5

1st assess 23-27 >37.5

2nd assess 23-27 <36.5

2nd assess 23-27 36.5-37.5

2nd assess 23-27 >37.5


27 to 31+6 weeks Temperature Tally, Jan-Jun 2019



ANTS N Wales NTS


KSS Peninsula 0

5

10

15

20

25

30

35

40

45

1st assess 27-32 <36.5

1st assess27-32 36.5-37.5

1st assess 27-32 >37.5

2nd assess 27-32 <36.5

2nd assess 27-32 36.5-37.5

2nd assess 27-32 >37.5

Premature Newborn Infants 27 to

31+6 weeks Temperature Tally, Jan-Jun 2019



ANTS N Wales NTS


KSS Peninsula 0%

25%

50%

75%

100%

1st assess 27-32 <36.5

1st assess27-32 36.5-37.5

1st assess 27-32 >37.5

2nd assess 27-32 <36.5

2nd assess 27-32 36.5-37.5

2nd assess 27-32 >37.5

Air Transport,

Jan-Jun 2016-19 Jan-Jun 2016 - 54 transfers undertaken by 4 services.

Jan-Jun 2017 - 59 transfers undertaken by 6 services.

Jan-Jun 2018 - 71 transfers undertaken by 7 services.

Jan-Jun 2019 - 95 transfers undertaken by 7 services

0

5

10

15

20

25

30

35

40

45



ANTS N Wales NTS


KSS Peninsula Jersey GH

2016 2017 2018 2019

Parents travelling on transport:

totals

0

50

100

150

200

250

300

350

400

450



ANTS N Wales NTS



Parents travelling on transport

as a percentage of total transfers

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%



ANTS N Wales NTS



Parents offered to travel on

transport totals

0

100

200

300

400

500

600

700



ANTS N Wales NTS



Parents offered to travel on

transport as a percentage of total transfers

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%



ANTS N Wales NTS



Service Characteristics 2019

24 hour service

0

2

4

6

8

10

12

14

16

18

2017 2018 2019

Yes No


Cot bureau

0

2

4

6

8

10

12

14

16

18

2017 2018 2019

Yes No


Conference calling

0

2

4

6

8

10

12

14

16

18

2017 2018 2019

Yes No

Service Characteristic- infants referred with

bile-stained vomiting/aspirates treated as time-critical

transfers ?

0

2

4

6

8

10

12

14

16

18

2017 2018 2019

Yes No

IUT Do you offer support for locating

appropriate maternal and neonatal beds for in-

utero transfers?

0

2

4

6

8

10

12

14

16

18

2017 2018 2019

Yes No

Dedicated vehicles,

2014-2019.

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

All Some None

2014 2015 2016 2017 2018 2019

Service process for

reviewing “wrong site” deliveries

Consultants

• Consultant

availability to

attend

transfers:

– Scheduled, all of

the time.

– Scheduled, some

of the time

– Maybe available,

ad-hoc.

– Never available

to attend.

0

2

4

6

8

10

12

14

All Some Ad-hoc None

2013 2014 2015 2016 2017 2018 2019

Conclusions/trends 2019

• Number of transfers trending rising again- blip or trend?

• Number of services stabilising.

• HFO and high-flow up.

• Time critical numbers down.

• Stabilising times are very variable- what is this telling us?

• Cooling now well established, timings very dependent on

referrer practice. Better looked at as network wide audits

than national level transport data?

• Lots of hypothermia at first assessment- will we see that

improve?

• Wide variation in rates of parents travelling with their

babies- work for 2020.

Acknowledgements

• All the service leads and team members

providing their data

• Colin Devon, ScotSTAR data analyst

• Andy Leslie, outgoing NTG data lead

NTG Annual Transport Data. 2019. -...

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