Teamwork in Retrieval Medicine

National Transport Medicine Programme

Dr David Menzies

National Lead, Adult Retrieval

Transport vs Retrieval

• ‘Sending’ patient

• Model 2, 3, (4) hospital to higher level of care

• Local team

• 999 Ambulance

• Non standardised

• ‘Collecting’ patient

• May add to level of care delivered

• Specialised team

• Critical Care Ambulance

• Standardised • Training • Equipment • SOPs

NTMP - Vision

• Comprehensive Retrieval-Transfer system:

• Available to all infants, children and adults within Ireland

• Integrated with and supports Model 2, 3 and 4 Hospitals

• Provides bi-directional inter-facility transport for patients with needs ranging from Critical Care to Intermediate Care

• Prioritises clinically urgent as well as non-clinically (system) urgent patients

• Cross Programme participation and collaboration

NTMP - Key Deliverables

1. Integrated system of clinical co‐ordination and operational tasking

2. Transport clinical staff who are skilled in the planning and delivery of emergency/critical care medicine

3. Standardised equipment for ground and air transport

4. Collection of transport data for systematic clinical and operational activity review and audit

5. An education programme that supports the programmes objectives

Integrated Programme

Governance Audit

Education

Adult

Paediatric

Neonates

NAS

(Air Corps)

NTMP Team

• Clinical Lead • Dr Dermot Doherty, Anne McCabe

• Adult Retrieval (MICAS) • Dr David Menzies, Anna Marie Murphy

• Paediatric Retrieval (IPATS) • Dr Cormac Breathnac, Lorraine Heery

• Neonatal Retrieval (NNTP) • Dr Jan Franta, Anne Bowden

Model

• Neonatal • Expansion to 24/7 service

• Paediatric • Develop 5 day (daytime)

retrieval service

• Adult • Develop 7 day (12 hours)

retrieval service based in Dublin, Cork & Galway

• Dublin – built on existing MICAS service

• NAS • Support for Transport

Programme

Governance

• Steering Committee

• Oversight of quality metrics / audit

• Four separate funding streams aggregated into the NTMP

• “Shared Service” • Offices in North Frederick

Street allowing co-location of Neonatal, Paediatric and Adult Retrieval Coordinators

Neonates

• Built upon the existing neonatal service

• From 2nd December 2013 24/7 service Service delivered by 3 hospitals - 1 week in 3 200 transfers since going 24/7 (66% after 5pm, 70% outside

Dublin) Estimated 550-600 transfers / year (from 300-350)

• Clinical Lead Dr Jan Franta (from April 2014)

• Education Cross hospital multi-disciplinary induction programme

July 2013 and January 2014

Paediatrics

• No existing service and centralised model of care 400 – 450 external transfers/year Of which 200-250 are neonates

• Plan for day time Monday to Friday service Change to model of implementation agreed using locum consultants

• Clinical lead Dr Cormac Breathanch (0.2wte)

• Outreach education to referring hospitals Initial session to all referring paediatric units during 2013 Sharing knowledge and improving pathways of communication

• Combined Neonatal & Paediatric Specialist Retrieval Expert Group, inaugural meeting April 2014

Adults

• Build on existing MICAS service Day time Monday – Friday

Does not meet demand (estimated at 1200 transports / year)

• Plan: 7 day week services 08:00 – 20:00 in Dublin, Cork and Galway

• Interim Lead Dr Rory Dwyer

• Adult Specialist Retrieval Expert Group inaugural meeting January 14

Ambulances

• 999 v ICVs Decision - ICVs unsuitable for

critical care transport But only small proportion of

inter-hospital transfers

• New ambulances for neonatal transport

• Protocol 37 To ensures inter-hospital

transports given appropriate priority alongside 999 calls

Education and Training

• Training programme to meet needs of: • Retrieval teams

• Referring hospitals

• Why outreach? • NTMP model means that

referring hospitals will continue to undertake some of their own transfers

• Will ‘always’ have to do time critical transfers

• Outreach education • 27 sessions in 2013 • S.T.A.B.L.E course delivered

neonatal & paediatric units • Positive evaluation • Builds relationships with

referring teams

• Retrieval training • Initial course delivered Cork • Plan for 12 regional 1 day

courses this year

Considerations / Future

• Recruitment – Issue particularly for adult / paediatrics

• Adaptation of implementation model

• More retrieval less transport

• Joint ownership of referred patient

• Further work on single point of contact for all retrievals

• Further integration transport equipment / platforms

• Development of lower level patient transfers

• Partnership working

Any questions?