Transfers

At the end of October, I wrote a brief entry about the Bliss Baby Charter, and said I'd return to it at a later date. Well just over 3 months after that, I guess this is a 'later date'!

For me, one of the burning issues in neonatal care is transfers, which is covered in Charter 3: Babies receive the nationally recommended level of specialist care in the nearest specialist unit to the baby's family home.

Within this, the charter requires trained specialist staff in multidisciplinary teams, near to home and operating consistently across a network. This isn't really too much to ask for is it? After all, it is pretty much what adults would also expect when they have a need for specialist medical care.

It is remarkable however, how often these objectives are not met. In particular, the provision of care 'near to home' is difficult for people to receive. There are many reasons why people are transferred, some quite legitimate, for example, transfers to a hospital that can provide higher levels of care, care for very premature babies or provide surgery.

Where things start to become unacceptable though is where it is purely a capacity issue and babies are transferred often many many miles from home simply because there is no cot closer to home. In a recent poll on the Bliss website (admittedly, this wasn't a scientifically rigorous study), nearly 20% of respondents were transferred between 50 and 100 miles, with more than 10% transferred over 100 miles. Some babies were transferred 140 milesor more, in one case 146 miles from Aberdeen to Glasgow, for a stay of 25 weeks! Even shorter transfers however can be traumatic, when it means a transfer further from home. Clearly the care of the preemie is paramount, and so where medical need dictates, transfers are fine. In other cases though, they risk:

• Stress and other impact on the baby during transfer and change of surroundings
• Transfer to a hospital where medical staff do not know the baby and its history as well
• Less frequent visits by parents due to extra distance and less time at the cot-side
  
• Less frequent visits by siblings
• Less frequent visits by other friends and family
• Stress to parents due to extra travel, unfamiliarity, less time with baby
  
• Increased time that parents and other children are apart during visits to visit the preemie
• Increased travel for already exhausted parents
• Increased travel costs
• Increased food costs, or poorer nutrition
  
• Reduced opportunity to establish breastfeeding
• Frustration with medical staff who don't know the background of the baby
• The risk of subsequent out patient treatment being either at the same far flung hospital, split amongst several hospitals or simply lost 'between the cracks'
• A new unit to become familiar with, and a change of routine

All this in what increasingly is being described as 'family centred care'! It often makes it worse when staff who have clearly seen it all before just don't see what the big deal is - to them it is just another day. There is also a point here about the consistent operation across networks. We know of families who managed to avoid transfer, and indeed there were respondents to the poll on the Bliss website who were able to beat the system. This isn't sour grapes and I'm genuinely pleased that people are able to stand up to the medical institution and overturn decisions, with babies that were on their way out being able to stay. There is also often poor communication on transfers, in terms of why they need to happen, how they will happen and also when they are likely to happen. Parents are often left feeling that they have no say in the decision. Ok, realistically they probably don't, but there is little discussion or communication with parents.

Finally, what must be the most stressful type of transfer is the multiple transfer, either being passed from pillar to post (and often back to the same post or another one!) or where multiple births are split up and sent their separate ways, often with mums still in-patients in hospital #1.

Clearly there are instances when transfers are absolutely necessary and all parents who are able to bring their baby home are enormously grateful, regardless of the distances travelled. But it would be good if transfers could be better planned, along the lines of the Bliss guidelines. Notably:

• Better communication with parents about the reasons for a transfer
• Transfers only when absolutely necessary for medical reasons
• Recognition that within family centred care, the parents and siblings should also be considered in addition to the non-medical impact on the baby (ie stress)
• Better communication with parents about the new hospital - car parking, visiting hours, NICU protocol (should you bring your own nappies, is there somewhere for valuables, when are ward rounds etc)
• Recognition that whilst networks are a good idea in general, there are instance where people living on the boundaries will be transferred to a hospital further from home even if transferred back into their own network (ok, I sneaked that in from personal experience, but we can't be the only ones that happened to)