Neonatal care levels criteria: framework for practice

6. Repatriation

‘Repatriation’ involves the timely return of a baby to their booking unit or to the closest appropriate unit meeting their current care requirements. Repatriation is integral to the effective delivery of integrated Neonatal care across NHS Scotland:

• All service users of Neonatal Care in Scotland should receive standardised written information at the time of initial admission or antenatally where neonatal care is anticipated. This information explains how Neonatal Care is delivered in NHS Scotland, the concept of the Neonatal Network, a description of the different types of units and the anticipation of planned repatriation to local units as soon as care requirements allow.
  • Parents should be prospectively informed by medical staff at the time of admission to a NICU/LNU that planned repatriation will occur at a later stage when clinical condition has stabilised.
  • Staff members should consistently document discussions on repatriation as an integral part of the delivery of care.
  • Throughout the period of stay in a NICU or LNU families should be reminded that repatriation to their booking unit or nearest appropriate unit is a normal and anticipated component of the planned care for all babies in NHS Scotland.
• Repatriation planning should commence when the baby meets eligibility criteria for the next level of unit for 48-hours and should occur within 48-hours of this decision that repatriation is appropriate being made.
• Individualised assessments of readiness for repatriation must be specific to each baby, recognising the clinical needs, available expertise and facilities and the unit-specific criteria in the preferred LNU/SCU.
• Planning should include referral to the Neonatal Transport Team at least one working day before anticipated repatriation to facilitate planning and workload prioritisation. Referral should follow the agreed national process for arranging such transfers. “Same day” repatriation requests should be reserved solely for capacity emergencies and should be the exception rather than standard practice.
• A clear record of when repatriation eligibility criteria have been met should be recorded in a consistent manner to facilitate audit.
• Robust handover processes for the transfer of clinical information are mandatory to underpin this model of Neonatal care. Direct communication between clinical staff in both units should occur during this time period to:
  • facilitate the exchange of clinical information.
  • Identify any outstanding investigations.
  • clearly document plans for follow-up.
  • summarise the knowledge and expectations parent/carers/family.
• Families should be involved in repatriation discussions occurring between units:
  • Once repatriation has been agreed and scheduled, families should be provided with information about the destination unit and a designated contact. The possibility that a return to the NICU may be required if their baby’s care needs escalate during their remaining stay in neonatal care should be highlighted prior to repatriation as this may occur and parents must appreciate this is not a reflection of an inappropriate initial repatriation.
• Other than for specific subspecialist follow-up (Cardiac, Surgical or Paediatric sub-speciality) the unit of booking will remain responsible for providing and arranging local follow-up.
• LNUs and SCUs have a responsibility to create the downstream capacity to facilitate the repatriation of a baby within 48-hours of the initial request, to protect NICU capacity for the sickest babies and to ensure that families are moved closer to home as soon as possible:
  • Once a baby does not meet NICU criteria, the relevant LNU or SCU are responsible for delivering the next stage of their care.
  • An inability to accept a repatriation transfer within the agreed timeframe and the reason why (unit capacity, staffing, infection control issues) must be escalated by the LNU/SCU to Senior Hospital management and will be recorded by exception reporting at Network level.