Antenatal maternal transfers in the east of England: role of a centralised cot bureau.

There are anecdotal reports of expecting mothers, likely to deliver an infant requiring neonatal intensive care, transferred between hospitals because of lack of local neonatal intensive care capacity. However, there are no data on the scale of this practice. The job of locating an admitting hospital often befalls the clinical staff on busy delivery units, taking them away from direct clinical care. Although this activity does not involve neonatal staff directly, it does raise questions about appropriate management of neonatal intensive care unit (NICU) resources locally especially with the development of neonatal networks. Recognising these issues, the regional neonatal transport service extended the role of the neonatal cot bureau to assist regional delivery units in locating suitable admitting hospitals. Starting inNovember 2003, and working from 0800 to 2030, the bureau operators asked the referring clinicians standard questions, including reasons for the transfer, the gestational age, as well as complications of pregnancy. The operators then phoned hospitals within and, if necessary, outside of the eastern region to locate one with suitable facilities. Once an admitting unit was identified, its contact details were relayed to the referring clinician for further discussions and transfer to take place. The bureau phoned the referring unit later to confirm if the transfer took place.Wewould like to share the results of this activity over the calendar year 2004. All 18 hospitals in the region used the service, making 262 transfer requests. Admitting units were identified in 179 (68%) cases; 42% of these units were outside of the region. A mean (range) of 7.6 (1–36) hospitals were contacted before an admitting unit could be located. Mean (range) time to locate the unit was 45 (6–215) minutes. Reasons for transfer request included: both delivery and NICU full locally, 11%; delivery unit full, 1.5%; NICU full, 54%; baby expected to be too premature for local NICU, 26%; other, 7%.Mean (range) gestational age at the time of transfer request was 29.5 (23–40) weeks. A total of 165 women were successfully transferred. These patients were transferred over a mean (range) distance of 66.5 (12–250) miles with mean (range) estimated journey time of 80 (14–300) minutes. Of the 85 women not transferred, no suitable admitting units could be located for 43%, transfer request was withdrawn by the referring unit in 38%, 11% delivered before they could be transferred, and admitting units declined after initial acceptance in 2%. No reason for non-transfer could be ascertained by the bureau in 5% of cases. This service is the only one of its kind in the United Kingdom. Although it does not capture the entire regional antenatal transfer activity, it has been of assistance to clinicians in the front line. These data suggest that maternal transfers take place regularly, often over long distances. Finding a suitable admitting unit is a time consuming task. Lack of local neonatal capacity and expertise is amajor underlying cause.While we await the results of current reconfiguration of maternal and neonatal care provision in the country, services similar to ours can help better management of available clinical resources. I U Cheema, R K Bomont