Neonatal Transport Data: An Opportunity for Quality Improvement

1
Neonatal Transport DataAn Opportunity for
Quality Improvement

• A product of
• California Perinatal Transport System (CPeTS)
• Managed by
• California Perinatal Quality Care Collaborative
  (CPQCC)

2
Continuing Education Credit

• After reviewing the materials in the Neonatal
  Transport Data System File and viewing the
  presentation, go to the following link to
  complete the post-test and evaluation.
• http//www.surveymonkey.com/s.asp?u815383080691

3
Objectives

• Understand the new Neonatal Transport Data
  System
• Demonstrate ability to correctly obtain and
  report data elements using agreed upon data
  definitions and procedures
• Demonstrate ability to complete on-line reporting
  of required data elements
• List 3 resources for assistance in completing
  data collection and
• Identify available reports that can be utilized
  among transport partners as part of Regional
  Cooperation Agreements, Joint Mortality and
  Morbidity Conferences and to identify education,
  consultation and policy needs.

4
Toward Improving the Outcome of Pregnancy II

• System For Regionalized Perinatal Care
• the development, within a geographic area, of a
  coordinated, cooperative system of maternal and
  perinatal health care in which, by mutual
  agreements between hospitals and physicians and
  based on population needs, the degree of
  complexity of maternal and perinatal care each
  hospital is capable of providing is identified so
  as to accomplish the following objectives
  quality care to all pregnant women and newborns,
  maximal utilization of highly trained perinatal
  personnel and intensive care facilities, and
  assurance of reasonable cost effectiveness.

March of Dimes, Birth Defects Foundation,
American College of Obstetricians and
Gynecologists, American Academy of Pediatrics,
1994.
5
California Perinatal Transport System (CPeTS)

• CPeTS was established by California Assembly Bill
  4439, in 1976.
• to facilitate transports of critically ill
  infants and mothers with high risk conditions to
  Neonatal Intensive Care Units (NICUs) and
  Perinatal High Risk Units.
• to collect and analyze perinatal and neonatal
  transport data for regional planning, outreach
  program development, and outcome analysis.
• CPeTS has engaged the California Quality Care
  Collaborative (CPQCC) to manage the data system.

6
Key Transport Issues Identified

• These issues included
• Perceived underutilization of maternal transport
  
• Perceived delay in decision to transport infant
• Difficulty in obtaining transport placement/
  acceptance
• Delay in effecting transport following decision
  and
• Consistent referring facility competency
  regarding infant stabilization prior to the
  transport teams arrival, as well as transport
  team competency.

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Title 22 - Hospital Licensing

• 70547 Perinatal Care Units
• (a4) Formal arrangements for consultation and/ or
  transfer of an infant to an intensive care
  newborn nursery, or a mother to a hospital with
  the necessary services for problems beyond the
  capability of the perinatal unit.
• (b) There shall be written policies and
  procedures developed and maintained by the person
  responsible for the service in consultation with
  other appropriate health professionals and
  administration. These policies and procedures
  shall reflect the standards and recommendations
  of the American College of Obstetricians and
  Gynecologistsand the American Academy of
  Pediatrics

California Code of Regulations, Title 22 Social
Security, Volume 28, Revised November, 1995.
Perinatal Unit General Requirements
8
AAP/ACOG Guidelines for Perinatal Care

• Recommends the following minimal regional
  evaluation of perinatal
• transport programs
• Patient Outcome Data
• Unexpected neonatal morbidity (eg, hypothermia or
  tension pneumothorax)
• Mortality during transport
• Morbidity or mortality of patients at the
  receiving hospital.
• Logistic Information
• Frequency of failure to transfer patients
  generally considered to require tertiary care
  (eg, newborns born at lt 32 weeks of gestation),
• Availability of all the services that may be
  needed by the perinatal patient,
• Accessibility of services,
• Capability to connect the patient quickly and
  appropriately with the services needed, and
• Programs to promote patient and community
  awareness of available and appropriate regional
  referral programs.

AAP/ACOG Guidelines for Perinatal Care, Fifth
Edition, 2002
9
California Childrens Services (CCS)

• 3.25.1-30 Infant morbidity and mortality data
  concerning birthweight, survival, transfer,
  incidence of certain conditions and other
  information as required shall be submitted to the
  Chief, Childrens Medical Services Branch/CCS
  Program annually.
• 4.A.(4) Maintenance of written records of each
  neonatal transport completed shall be available
  for review by CCS program staff.
• 4B.All guidelines and reporting requirements of
  the Regional Perinatal Dispatch Center shall be
  followed.

California Childrens Services (CCS) Manual of
Procedures, Chapter 3 Provider Standards,
Section 3.25 Standards for Neonatal Intensive
Care Units (NICUs), State of California,
Department of Health Services, California Medical
Services, January 1, 1999.
10
Policy

• A Neonatal Transport Form must be completed for
  all neonates acutely transferred to or from a
  CCS-designated NICU, as well as all facilities
  participating in CPQCC.
• Selected data elements will be electronically
  reported via the CPQCC Transport Activity Report

11
Materials

• All California Neonatal Transport Form (ACNTF)
• Core CPeTS Neonatal Transport Form (CCNTF)
• Color-coded All California Neonatal Transport
  Form
• Policy and Procedure
• 2007 Data Definitions and Training Manual
• Sample Reports
• Educational Presentation
• Articles
• Transport risk index of physiologic stability
  (TRIPS) A practical
• system for assessing infant transport care by
  Lee, S.K., et al. (J Peds, Vol. 139, No. 2,
  220-226, August, 2001)
• The Mortality Index for Neonatal Transportation
  Score A New Mortality Prediction Model for
  Retrieved Neonates by Broughton, S.J. et al.
  (Pediatrics, Vol. 114, No. 4, 424-428, April 20,
  2004)

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Data Collection Responsibility

• Completing a neonatal transport record is the
• joint responsibility of the referring and
  receiving hospital.
• Data elements to be completed by the referring
  hospital are shown in 10 gray scale.
• Data to be completed by the transport team or
  receiving facility are shown in 15 gray scale on
  the actual form.
• Information collected for continuity of care
  should be completed by members of both the
  referring and receiving hospitals in order to
  ensure safe and effective transfer of care.
• Sections that pertain to quality improvement
  issues can be completed by staff from either
  facility. This page should be separated prior to
  placing the form into the patient record. The
  separated section is then handled following
  internal hospital policies for QI data.

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Referring Hospital

• Initiate form when a neonate is identified as a
  potential candidate for acute transport to
  another facility.
• Information requested in the following sections
  should be obtained prior to calling the receiving
  hospital. This information is necessary in order
  to assess patient stability, potential
  complications and to co-manage care prior to
  transfer of care.
• Referral Information
• Patient Identification/History
• Infant Condition Modified TRIPS Score
• Provide to the receiving hospital at the time of
  the referring call.
• Completing the form prior to the call and faxing
  this information to the receiving facility will
  help to ensure safe and effective hand off of
  patients between providers.

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Data Collection

• Patient condition should be the driving force in
  timing of transport initiation.
• Delay in referral to collect data should be
  avoided.
• If specific information is not available at the
  initial call it can be transmitted by telephone
  or fax to the transport team or receiving
  hospital prior to departure for the referring
  facility.

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Referral Information required at initial contact between referring and receiving center/providers to facilitate transport. Referral Information required at initial contact between referring and receiving center/providers to facilitate transport. Referral Information required at initial contact between referring and receiving center/providers to facilitate transport. Referral Information required at initial contact between referring and receiving center/providers to facilitate transport.
T.1 Transport type ? DR Attendance Requested ? ASAP Neonatal ? Scheduled Neonatal ? Other ________________ T.1 Transport type ? DR Attendance Requested ? ASAP Neonatal ? Scheduled Neonatal ? Other ________________ T.1 Transport type ? DR Attendance Requested ? ASAP Neonatal ? Scheduled Neonatal ? Other ________________ T.1 Transport type ? DR Attendance Requested ? ASAP Neonatal ? Scheduled Neonatal ? Other ________________
T.2 Indication ? Medical Dx/Rx Services ? Growth/Discharge Planning ? Surgery ?Chronic Care ? Insurance T.2 Indication ? Medical Dx/Rx Services ? Growth/Discharge Planning ? Surgery ?Chronic Care ? Insurance T.2 Indication ? Medical Dx/Rx Services ? Growth/Discharge Planning ? Surgery ?Chronic Care ? Insurance T.2 Indication ? Medical Dx/Rx Services ? Growth/Discharge Planning ? Surgery ?Chronic Care ? Insurance
T.3 Date/Time(D/T) Referral _at_ T.4 Acceptance _at_ T.3 Date/Time(D/T) Referral _at_ T.4 Acceptance _at_ T.3 Date/Time(D/T) Referral _at_ T.4 Acceptance _at_ T.3 Date/Time(D/T) Referral _at_ T.4 Acceptance _at_
T.5 Maternal Admission to Labor Delivery/Hospital Date/Time _at_ T.5 Maternal Admission to Labor Delivery/Hospital Date/Time _at_ T.5 Maternal Admission to Labor Delivery/Hospital Date/Time _at_ T.5 Maternal Admission to Labor Delivery/Hospital Date/Time _at_
Patient Identification/History Information to be obtained prior to transport. Patient Identification/History Information to be obtained prior to transport. Patient Identification/History Information to be obtained prior to transport. Patient Identification/History Information to be obtained prior to transport.
Infants Name___________________? Singleton ? Multiple __of __ T.6 Birth D/T _________ _at_______Ins. ___________ Infants Name___________________? Singleton ? Multiple __of __ T.6 Birth D/T _________ _at_______Ins. ___________ Infants Name___________________? Singleton ? Multiple __of __ T.6 Birth D/T _________ _at_______Ins. ___________ Infants Name___________________? Singleton ? Multiple __of __ T.6 Birth D/T _________ _at_______Ins. ___________
T.7 Birth wt. __ __ __ __ gms Current wt. __ __ __ __ gms T.8 Gestational Age __ __wks__ days T.9 ? M ?F ?Unk T.7 Birth wt. __ __ __ __ gms Current wt. __ __ __ __ gms T.8 Gestational Age __ __wks__ days T.9 ? M ?F ?Unk T.7 Birth wt. __ __ __ __ gms Current wt. __ __ __ __ gms T.8 Gestational Age __ __wks__ days T.9 ? M ?F ?Unk T.7 Birth wt. __ __ __ __ gms Current wt. __ __ __ __ gms T.8 Gestational Age __ __wks__ days T.9 ? M ?F ?Unk
T.10 Prenatally Diagnosed Congenital Anomalies ? Y ? N ? Unk Describe T.10 Prenatally Diagnosed Congenital Anomalies ? Y ? N ? Unk Describe T.10 Prenatally Diagnosed Congenital Anomalies ? Y ? N ? Unk Describe T.10 Prenatally Diagnosed Congenital Anomalies ? Y ? N ? Unk Describe
Mothers Name Birth Date Age __ __ yrs MedRec Mothers Name Birth Date Age __ __ yrs MedRec Mothers Name Birth Date Age __ __ yrs MedRec Mothers Name Birth Date Age __ __ yrs MedRec
T.11 G __ P ? AB ? L ? ROM Date/Time _at_ Duration __ __ hrs Fluid ? Clear ? Meconium T.11 G __ P ? AB ? L ? ROM Date/Time _at_ Duration __ __ hrs Fluid ? Clear ? Meconium T.11 G __ P ? AB ? L ? ROM Date/Time _at_ Duration __ __ hrs Fluid ? Clear ? Meconium T.11 G __ P ? AB ? L ? ROM Date/Time _at_ Duration __ __ hrs Fluid ? Clear ? Meconium
Antenatal Conditions ? None ? Unk ? Hypertension ? Diabetes ? Infection ? Preterm Labor ? Bleeding/Abrupt/Previa ? Other _____________ Significant Antepartum/Intrapartum Issues Delivery ? Spont. Vag ? Op. Vag ?Vacuum ? Forceps ? Cesarean ? Primary ? Repeat Apgar Scores Score N/D Unk 1 __ __ ? ? 5 __ __ ? ? 10__ __ ? ? 15__ __ ? ? ___________ ___________
Antenatal Conditions ? None ? Unk ? Hypertension ? Diabetes ? Infection ? Preterm Labor ? Bleeding/Abrupt/Previa ? Other _____________ Antibiotics ?Y Specify__________ ?N ?Unk Delivery ? Spont. Vag ? Op. Vag ?Vacuum ? Forceps ? Cesarean ? Primary ? Repeat Apgar Scores Score N/D Unk 1 __ __ ? ? 5 __ __ ? ? 10__ __ ? ? 15__ __ ? ? ___________ ___________
Antenatal Conditions ? None ? Unk ? Hypertension ? Diabetes ? Infection ? Preterm Labor ? Bleeding/Abrupt/Previa ? Other _____________ T.12 Steroids ?Y ?N (last dose) _at_ Delivery ? Spont. Vag ? Op. Vag ?Vacuum ? Forceps ? Cesarean ? Primary ? Repeat Apgar Scores Score N/D Unk 1 __ __ ? ? 5 __ __ ? ? 10__ __ ? ? 15__ __ ? ? ___________ ___________
Antenatal Conditions ? None ? Unk ? Hypertension ? Diabetes ? Infection ? Preterm Labor ? Bleeding/Abrupt/Previa ? Other _____________ T.13 Surfactant Given ?Y ?N ?Unk ? DR ? NSY ?NICU(first dose) _at_ Delivery ? Spont. Vag ? Op. Vag ?Vacuum ? Forceps ? Cesarean ? Primary ? Repeat Apgar Scores Score N/D Unk 1 __ __ ? ? 5 __ __ ? ? 10__ __ ? ? 15__ __ ? ? ___________ ___________
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Modified TRIPS Scores

• The modified Transport Risk Index of Physiologic
  Stability (TRIPS) Score contained in the Infant
  Condition Section will provide uniform assess of
  patient status and stability
• Obtained three times
• Within 15 minutes of the time of referral by
  referring hospital staff
• Within 15 minutes of transport team arrival at
  referring facility by transport team
• Within 15 minutes of team return to receiving
  NICU by receiving hospital staff

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Critical Components of the Modified TRIPS Score

• Responsiveness
• Respiratory Status
• Oxygen Index completed if patient is on
  mechanical ventilation only
• Vital Signs
• Blood Glucose
• Blood Gases (if obtained) and type of respiratory
  support provided

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Modified TRIPS Score to be recorded on referral, within 15 minutes of arrival at referring hospital and admit to NICU. Modified TRIPS Score to be recorded on referral, within 15 minutes of arrival at referring hospital and admit to NICU. Modified TRIPS Score to be recorded on referral, within 15 minutes of arrival at referring hospital and admit to NICU. Modified TRIPS Score to be recorded on referral, within 15 minutes of arrival at referring hospital and admit to NICU. Modified TRIPS Score to be recorded on referral, within 15 minutes of arrival at referring hospital and admit to NICU. Modified TRIPS Score to be recorded on referral, within 15 minutes of arrival at referring hospital and admit to NICU.
Referral a Initial TT Eval b NICU Admit c
T.14 Time (24 hour) T.14 Time (24 hour) T.14 Time (24 hour)
T.15 Responsiveness? T.15 Responsiveness? T.15 Responsiveness?
Respiratory T.16 Rate T.16 Rate
Respiratory T.17 O2 Saturation T.17 O2 Saturation
Respiratory T.18 Status? T.18 Status?
Respiratory Oxygen Index T.19 MAP
Respiratory Oxygen Index T.19 FiO2
Respiratory Oxygen Index T.19 PAO2
Vital Signs T.20 HR T.20 HR
Vital Signs T.21 BP Sys/ Dia, Mean T.21 BP Sys/ Dia, Mean
Vital Signs T.22 Pressors T.22 Pressors ?Y ?N ?Y?N ?Y ?N
Vital Signs T.23 Temp. C T.23 Temp. C
T.24 Blood Glucose T.24 Blood Glucose T.24 Blood Glucose
Bld. Gas T.25 Resp. Support? T.25 Resp. Support?
Bld. Gas pH pH
Bld. Gas PCO2 PCO2
Bld. Gas BE BE
?Responsiveness 0Death 1None, Seizure, Muscle Relaxant 2Lethargic, no cry 3Vigorously withdraws, cry. ?Resp Support None, Hood/NC. NCPAP, ETT ?Respiratory Status 1Respirator 2 Severe (apnea, gasping, intubated but not on respirator) 3Other Oxygen Index completed if pt. is on vent. ?Responsiveness 0Death 1None, Seizure, Muscle Relaxant 2Lethargic, no cry 3Vigorously withdraws, cry. ?Resp Support None, Hood/NC. NCPAP, ETT ?Respiratory Status 1Respirator 2 Severe (apnea, gasping, intubated but not on respirator) 3Other Oxygen Index completed if pt. is on vent. ?Responsiveness 0Death 1None, Seizure, Muscle Relaxant 2Lethargic, no cry 3Vigorously withdraws, cry. ?Resp Support None, Hood/NC. NCPAP, ETT ?Respiratory Status 1Respirator 2 Severe (apnea, gasping, intubated but not on respirator) 3Other Oxygen Index completed if pt. is on vent. ?Responsiveness 0Death 1None, Seizure, Muscle Relaxant 2Lethargic, no cry 3Vigorously withdraws, cry. ?Resp Support None, Hood/NC. NCPAP, ETT ?Respiratory Status 1Respirator 2 Severe (apnea, gasping, intubated but not on respirator) 3Other Oxygen Index completed if pt. is on vent. ?Responsiveness 0Death 1None, Seizure, Muscle Relaxant 2Lethargic, no cry 3Vigorously withdraws, cry. ?Resp Support None, Hood/NC. NCPAP, ETT ?Respiratory Status 1Respirator 2 Severe (apnea, gasping, intubated but not on respirator) 3Other Oxygen Index completed if pt. is on vent. ?Responsiveness 0Death 1None, Seizure, Muscle Relaxant 2Lethargic, no cry 3Vigorously withdraws, cry. ?Resp Support None, Hood/NC. NCPAP, ETT ?Respiratory Status 1Respirator 2 Severe (apnea, gasping, intubated but not on respirator) 3Other Oxygen Index completed if pt. is on vent. ?Responsiveness 0Death 1None, Seizure, Muscle Relaxant 2Lethargic, no cry 3Vigorously withdraws, cry. ?Resp Support None, Hood/NC. NCPAP, ETT ?Respiratory Status 1Respirator 2 Severe (apnea, gasping, intubated but not on respirator) 3Other Oxygen Index completed if pt. is on vent.
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Referring Hospital

• The following sections should be completed prior
  to transport with the most current data
  available.
• Clinical Information
• Other Significant Issues
• Referral Process
• Information / Materials Sent with Transport Team
  and Care Providers.
• Additional comments, documentation of procedures,
  patient response to procedures and other
  significant information can be recorded in the
  Comments section at any point in the transport
  process.

20
Clinical Information Clinical Information
Date Time Results
Hgb/HCT _at_
Bld. Cult. _at_
Bilirubin _at_
Screening Hearing ?Y ?N ? Unk Metabolic ?Y ?N ?Unk
Subs Exp ?Y ?N ?Ukn
Imaging CXR _at_
Other (specify)
IV Access/Fluids (type, rate, site)
Bld. Trans. _at_ (type,vol)
Last Urine _at_ Stool _at_
Feeding (type/rt/vol) First Last
Meds given within last 24 ? Eye care ? Vit. K
Date/Time Med Dose Rt.



Allergies ?Y type ? N ?Unk
Surgery ?Y ? N Indication ?NEC ? CHD ? Other
Death?No ?Yes _at_ ? Prior to team arrival ? Prior to departure ? Prior to arrival at NICU
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Transport Team/Receiving Hospital

• Transport team/Receiving hospital staff should
  review all information in the following sections.
  
• Referral Information
• Patient Identification/History
• Infant Condition Modified TRIPS Score (referral)
  sections. Upon return to receiving NICU (within
  15 minutes of arrival) the third and final (NICU
  admit) Infant Condition Modified TRIPS Score
  section should be completed. Infant Condition
  Modified TRIPS Score (referral) sections.
• On arrival at the referring hospital, the
  transport team members are responsible for
  assigning the second Infant Condition Modified
  TRIPS Score section within 15 minutes of arrival
  (Initial Transport Team).

22
Modified TRIPS Score to be recorded on referral, within 15 minutes of arrival at referring hospital and admit to NICU. Modified TRIPS Score to be recorded on referral, within 15 minutes of arrival at referring hospital and admit to NICU. Modified TRIPS Score to be recorded on referral, within 15 minutes of arrival at referring hospital and admit to NICU. Modified TRIPS Score to be recorded on referral, within 15 minutes of arrival at referring hospital and admit to NICU. Modified TRIPS Score to be recorded on referral, within 15 minutes of arrival at referring hospital and admit to NICU. Modified TRIPS Score to be recorded on referral, within 15 minutes of arrival at referring hospital and admit to NICU.
Referral a Initial TT Eval b NICU Admit c
T.14 Time (24 hour) T.14 Time (24 hour) T.14 Time (24 hour)
T.15 Responsiveness? T.15 Responsiveness? T.15 Responsiveness?
Respiratory T.16 Rate T.16 Rate
Respiratory T.17 O2 Saturation T.17 O2 Saturation
Respiratory T.18 Status? T.18 Status?
Respiratory Oxygen Index T.19 MAP
Respiratory Oxygen Index T.19 FiO2
Respiratory Oxygen Index T.19 PAO2
Vital Signs T.20 HR T.20 HR
Vital Signs T.21 BP Sys/ Dia, Mean T.21 BP Sys/ Dia, Mean
Vital Signs T.22 Pressors T.22 Pressors ?Y ?N ?Y?N ?Y ?N
Vital Signs T.23 Temp. C T.23 Temp. C
T.24 Blood Glucose T.24 Blood Glucose T.24 Blood Glucose
Bld. Gas T.25 Resp. Support? T.25 Resp. Support?
Bld. Gas pH pH
Bld. Gas PCO2 PCO2
Bld. Gas BE BE
?Responsiveness 0Death 1None, Seizure, Muscle Relaxant 2Lethargic, no cry 3Vigorously withdraws, cry. ?Resp Support None, Hood/NC. NCPAP, ETT ?Respiratory Status 1Respirator 2 Severe (apnea, gasping, intubated but not on respirator) 3Other Oxygen Index completed if pt. is on vent. ?Responsiveness 0Death 1None, Seizure, Muscle Relaxant 2Lethargic, no cry 3Vigorously withdraws, cry. ?Resp Support None, Hood/NC. NCPAP, ETT ?Respiratory Status 1Respirator 2 Severe (apnea, gasping, intubated but not on respirator) 3Other Oxygen Index completed if pt. is on vent. ?Responsiveness 0Death 1None, Seizure, Muscle Relaxant 2Lethargic, no cry 3Vigorously withdraws, cry. ?Resp Support None, Hood/NC. NCPAP, ETT ?Respiratory Status 1Respirator 2 Severe (apnea, gasping, intubated but not on respirator) 3Other Oxygen Index completed if pt. is on vent. ?Responsiveness 0Death 1None, Seizure, Muscle Relaxant 2Lethargic, no cry 3Vigorously withdraws, cry. ?Resp Support None, Hood/NC. NCPAP, ETT ?Respiratory Status 1Respirator 2 Severe (apnea, gasping, intubated but not on respirator) 3Other Oxygen Index completed if pt. is on vent. ?Responsiveness 0Death 1None, Seizure, Muscle Relaxant 2Lethargic, no cry 3Vigorously withdraws, cry. ?Resp Support None, Hood/NC. NCPAP, ETT ?Respiratory Status 1Respirator 2 Severe (apnea, gasping, intubated but not on respirator) 3Other Oxygen Index completed if pt. is on vent. ?Responsiveness 0Death 1None, Seizure, Muscle Relaxant 2Lethargic, no cry 3Vigorously withdraws, cry. ?Resp Support None, Hood/NC. NCPAP, ETT ?Respiratory Status 1Respirator 2 Severe (apnea, gasping, intubated but not on respirator) 3Other Oxygen Index completed if pt. is on vent. ?Responsiveness 0Death 1None, Seizure, Muscle Relaxant 2Lethargic, no cry 3Vigorously withdraws, cry. ?Resp Support None, Hood/NC. NCPAP, ETT ?Respiratory Status 1Respirator 2 Severe (apnea, gasping, intubated but not on respirator) 3Other Oxygen Index completed if pt. is on vent.
23
Transport Team/Receiving Hospital

• The following sections should be completed prior
  to transport with the most current data available
  in consultation with staff from the referring
  facility.
• Clinical Information
• Other Significant Issues
• Referral Process
• Timeline
• Information / Materials Sent with Transport Team
  and Care Providers
• Additional comments, documentation of procedures,
  patient response to procedures and other
  significant information can be recorded in the
  Comments section at any point in the transport
  process.

24
Clinical Information Clinical Information
Date Time Results
Hgb/HCT _at_
Bld. Cult. _at_
Bilirubin _at_
Screening Hearing ?Y ?N ? Unk Metabolic ?Y ?N ?Unk
Subs Exp ?Y ?N ?Ukn
Imaging CXR _at_
Other (specify)
IV Access/Fluids (type, rate, site)
Bld. Trans. _at_ (type,vol)
Last Urine _at_ Stool _at_
Feeding (type/rt/vol) First Last
Meds given within last 24 ? Eye care ? Vit. K
Date/Time Med Dose Rt.



Allergies ?Y type ? N ?Unk
Surgery ?Y ? N Indication ?NEC ? CHD ? Other
Death?No ?Yes _at_ ? Prior to team arrival ? Prior to departure ? Prior to arrival at NICU
25
Referral Process
T.26 Referring Hospital Name
Code Telephone Number
Referring OB
Referring Peds
Informant
T.27 Previously Transported? ?Y ?N From Hospital Name Code
T.28 Birth Hospital (if not listed above) Hospital Name Code
Receiving Hospital Accepting Physician
T.29 Trans. Team On-Site Leader ?Sub-specialist MD ?Peds ?Other MD/Resident ?NNP ?Transport Spec. ?Nurse Present prior to transport team arrival ?Y ?N _at_
T.30 Team From ? Receiving Hospital ?Contract Service (CPQCC TT ID ) ? Referring Hosp.
T.31 Mode ?Ground ?Helicopter ?Fixed Wing Indication Transport Carrier
26
Timeline
Date Time Comments
T.32 Transport Team Departure for Referring Hospital _at_
T.33 Transport Team Arrival at Referring Hospital _at_
Transport Team Departure from Referring Hospital _at_
Transport Team Arrival at Receiving Facility _at_
Information/Materials To Be Sent With Transport Team (check all provided)
Chart (pt. record) ?Maternal ?Neonatal Blood Specimen ?Maternal ?Neonatal ?Placenta ?Imagining copies
?Other, specify
Care Providers name /title signature D/T of arrival
Referring Hospital _at_
_at_
Transport Team _at_
_at_
_at_
_at_
27
Confidential Neonatal Transport Improvement
Potential

• Information gathered at any point during the
  resuscitation, stabilization, referral, and
  transport process regarding quality improvement
  issues, may be recorded in the Confidential
  Neonatal Transport Issues with Improvement
  Potential Form.
• Form should be separated from the first two pages
  of the form prior to placing the form into the
  patient record. The separated section is then
  handled following internal hospital policies for
  QI data.
• Issues identified should reviewed jointly by
  referring and receiving hospitals staff at
  Mortality and Morbidity Reviews, annual review of
  Regional Cooperation Agreement or other
  appropriate QI venue.
• These issues may also be used to identify joint
  policy and procedure requirements, educational
  opportunities and or gaps in services that should
  be referred to team responsible for annual review
  and negotiation of the Memorandum of
  Understanding (MOU).

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Transport Issues with Improvement Potential (Quality Improvement Data)
?Delay in transport, describe ______________________________________________ Related to ?Amb./vehicle issues ?Traffic ?Missed opportunity for maternal transport ?Delay in transferring infant ?Transport Team Difficulties, describe _______________________________________ ? Required elements of elements form incomplete, describe _____________ ?Equipment Difficulties, describe __________________________________________ ?Unplanned Intervention During Transport, describe ____________________________ Related to ?Airway ?Vascular Access ?Return to Referring Hospital ?Other _______________________________ ?CPR during transport ?Death prior to admission to receiving NICU ?None ?Other, describe
29
Comments






Referred for Joint Mortality/Morbidity Review ?Y ?N ? Unk Date of Review
Outcome of Review ?Policy/Procedure Change ?Joint QI Project ?Education Offering ?Consultation
? Other describe

Follow up
30
On-line Reporting of Data

• Selected data elements (found in Red highlighted,
  BOLD on the sample and NTR forms) will be
  electronically reported via the CPQCC Transport
  Activity Report.
• This reporting should take place following the
  transport but prior to submitting routine
  Admission/Discharge Data to the CPQCC. All
  transported patients are eligible for inclusion
  in the CPQCC dataset.

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Data Definitions

• Data definitions and directions for completing
  each item on the NTR can be found in the attached
  2007 Manual of Definitions Neonatal Transport
  Data Collection Tools.

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RECEIVING HOSPITAL REPORT RECEIVING HOSPITAL REPORT RECEIVING HOSPITAL REPORT RECEIVING HOSPITAL REPORT RECEIVING HOSPITAL REPORT RECEIVING HOSPITAL REPORT
Acute Transport Activity Acute Transport Activity Acute Transport Activity Acute Transport Activity Acute Transport Activity Acute Transport Activity Acute Transport Activity Acute Transport Activity Acute Transport Activity Acute Transport Activity Acute Transport Activity Acute Transport Activity Acute Transport Activity Acute Transport Activity Acute Transport Activity
Infants 1,500 grams or less born between 01/01/2006 and 12/31/2006 Infants 1,500 grams or less born between 01/01/2006 and 12/31/2006 Infants 1,500 grams or less born between 01/01/2006 and 12/31/2006 Infants 1,500 grams or less born between 01/01/2006 and 12/31/2006 Infants 1,500 grams or less born between 01/01/2006 and 12/31/2006 Infants 1,500 grams or less born between 01/01/2006 and 12/31/2006 Infants 1,500 grams or less born between 01/01/2006 and 12/31/2006 Infants 1,500 grams or less born between 01/01/2006 and 12/31/2006 Infants 1,500 grams or less born between 01/01/2006 and 12/31/2006 Infants 1,500 grams or less born between 01/01/2006 and 12/31/2006 Infants 1,500 grams or less born between 01/01/2006 and 12/31/2006 Infants 1,500 grams or less born between 01/01/2006 and 12/31/2006 Infants 1,500 grams or less born between 01/01/2006 and 12/31/2006 Infants 1,500 grams or less born between 01/01/2006 and 12/31/2006 Infants 1,500 grams or less born between 01/01/2006 and 12/31/2006
    Center Center Center Center Center Center Same CCS Level within CPQCC Same CCS Level within CPQCC Same CCS Level within CPQCC Same CCS Level within CPQCC Same CCS Level within CPQCC Same CCS Level within CPQCC Center-Network Comparison
    (N141) (N141) (N141) (N141) (N141) (N141) (N Centers94 ) (N Centers94 ) (N Centers94 ) (N Centers94 ) (N Centers94 ) (N Centers94 ) Center-Network Comparison
    N N Last Year's Last Year's Median Median Lower Quartile Lower Quartile Upper Quartile Upper Quartile Center-Network Comparison
Acute Transport Type Acute Transport Type Acute Transport Type Acute Transport Type Acute Transport Type Acute Transport Type Acute Transport Type Acute Transport Type Acute Transport Type Acute Transport Type Acute Transport Type Acute Transport Type Acute Transport Type Acute Transport Type Acute Transport Type
  Dr Attendance Requested 43   30.5   30.6   25   19   30  
ASAP Neonatal 71   50.4   50.6   41 35 50
Scheduled Neonatal 27   19.1   17.6   32 24 39
  Other 0   0   1.2   0   0   2  
Birth Weight Birth Weight Birth Weight Birth Weight Birth Weight Birth Weight Birth Weight Birth Weight Birth Weight Birth Weight Birth Weight Birth Weight Birth Weight Birth Weight Birth Weight
For a finer birth weight breakdown, click here. For a finer birth weight breakdown, click here. For a finer birth weight breakdown, click here. For a finer birth weight breakdown, click here. For a finer birth weight breakdown, click here. For a finer birth weight breakdown, click here. For a finer birth weight breakdown, click here. For a finer birth weight breakdown, click here. For a finer birth weight breakdown, click here. For a finer birth weight breakdown, click here. For a finer birth weight breakdown, click here. For a finer birth weight breakdown, click here. For a finer birth weight breakdown, click here. For a finer birth weight breakdown, click here. For a finer birth weight breakdown, click here.
  750 grams or less 28   19.9   19.4   24   16   28  
751-1,000 grams 35   24.8   24.1   21 15 27  
  1,001-1,500 grams 78   55.3   56.5   55   47   65  
Gestational Age Gestational Age Gestational Age Gestational Age Gestational Age Gestational Age Gestational Age Gestational Age Gestational Age Gestational Age Gestational Age Gestational Age Gestational Age Gestational Age Gestational Age
For a finer gestational age breakdown, click here. For a finer gestational age breakdown, click here. For a finer gestational age breakdown, click here. For a finer gestational age breakdown, click here. For a finer gestational age breakdown, click here. For a finer gestational age breakdown, click here. For a finer gestational age breakdown, click here. For a finer gestational age breakdown, click here. For a finer gestational age breakdown, click here. For a finer gestational age breakdown, click here. For a finer gestational age breakdown, click here. For a finer gestational age breakdown, click here. For a finer gestational age breakdown, click here. For a finer gestational age breakdown, click here. For a finer gestational age breakdown, click here.
  under 25 weeks 19   13.5   13.5   16   11   20  
25 to 27 weeks 43   30.5   35.3   27 20 33  
28 to 30 weeks 56   39.7   32.4   36 30 40
31 to 33 weeks 21   14.9   17.1   16 13 23
34 to 37 weeks 2   1.4   1.8   2 0 5
  38 to 41 weeks 0   0   0   0   0   0  
 
 
 
33
Thank You!
34

• Neonatal Transport Data Work Group
• Allen Fischer, MD
• Philippe S. Friedlich, MD
• Balaji Govindaswami, MD, MPH
• Andrew Hopper, MD
• Robert Kahle, MD
• Frank L. Mannino, M.D.
• Gil Martin, MD
• Rod Phibbs, MD
• Francis Poulain, MD
• Bob Roth, MD
• Terri Slagle, MD
• Leslie Williams
• Data Collection Advisory Committee
• Jeanetter Asselin
• Grace Villarin Duenas

• Co-Chairs
• Jeffrey Gould, MD, MPH
• Al Hackel, MD
• Staff
• D. Lisa Bollman, RNC, MSN
• Barbara Murphy, RN, MSN
• Grace Villarin Duenas
• Dani Kerns
• Katherine Cross
• Beate Danielsen
• Pemita Paaga
• Fulani Irving

35
Key Informants Focus Group Participants

• Northern California
• Jackie Bagatta
• Laura Berrito
• Alice Black
• Michelle Cordova
• Robin Courtney
• Jo Danner
• Louise Fry
• Al Hackel
• Allan Fischer
• Allan Fishman
• Mary Lynch
• Barbara Mochizuki
• Barbara Murphy
• Lois Owen
• Rod Phibbs
• Richard Powers
• Gloria Santos
• Pamela Stanley

• Southern California
• D. Lisa Bollman
• Uday Devaskar
• Vijay Dhar
• Ralph E. Franceschini
• Phillippe S. Friedlich
• Mary Goldberg
• Balaji Govindaswami
• Jeff Gould
• Al Hackel
• Sudeep Kukreja
• Frank Mannino
• Sally McGann
• Andy Mossa
• Barbara Murphy
• Mark Speziale
• Arthur Strauss
• Sophia Tse
• Cherry Uy

36
Beta Test Facilities

• California Medical Center
• Childrens Hospital of Central California
• Childrens Hospital Research Center at Oakland
• Lucille Packard Children Hospital at Stanford
• Presbyterian Intercommunity Medical Center
• Santa Clara Valley Medical Center
• St. Francis Medical Center
• St. Mary Medical Center
• Sutter Memorial Hospital, Sacramento
• University of California, Davis Medical Center
• University of California, San Francisco

37
Special thanks to the following groups for their
input review and advice

• CPQCC
• Executive Committee
• Perinatal Quality Improvement Committee
• Data Collection Advisory Group
• Data Center Staff
• CPeTS
• Executive Committee
• Northern California Perinatal Quality Improvement
  Committee
• Southern California Perinatal Quality Improvement
  Committee

• Regional Perinatal Programs of
• California
• California Department of Health
• Services, Maternal, Child and
• Adolescent Health Branch/Office
• of Family Planning and
• Childrens Medical Services
• (CMS) California Childrens
• Services (CCS)