Neonatal care levels criteria: framework for practice

8. Processes to Support Implementation and Review of Pathways of Care

A standardised national exception reporting process will be developed by the National Neonatal Network to support the implementation and monitor the delivery of care under the new model described within this framework. Such a process will allow the National Neonatal Network, individual units and clinicians to review exceptions to the pathways, recognise areas of good performance and identify those areas requiring prioritisation for service change at a regional and/or national level.

8.1 Indications for Exception Reporting:

(i) If a NICU cannot accept an appropriate LNU transfer due to capacity issues within the NICU an exception report will be completed by the LNU and reported at Network level. It should be the expectation that the nearest geographical NICU should be able to accept and prioritise a LNU transfer request and if transfer is required beyond the nearest geographical NICU the reason for this should also be clearly recorded and reported at Network level.

(ii) To record babies meeting NICU criteria who deliver in a LNU or SCU, recognising that in some cases this will be unavoidable, including a review in a standardised manner of the obstetric and neonatal decision-making in each case.

(iii) To review clinical care episodes when babies receive on-going complex ITU care within a LNU > 48 hours, recognising that in some cases appropriate two-way clinical dialogue will have agreed this to be the most appropriate location of care (e.g. if a baby is improving and about to be extubated).

(iv) Delays in repatriation to the nearest clinically appropriate unit for non-clinical reasons (lack of capacity, lack of transport availability). Such examples would include the inability of a LNU or SCU to accept repatriation transfer from a NICU or LNU where staff have appropriately followed the repatriation pathway.