Neonatal Care in Scotland: A Quality Framework

3.6 Timely

Neonates will be cared for in the right place, at the right time and by the right people with the right skills.

A high quality neonatal service will demonstrate timely provision of clinical care, minimised delays in emergency transfer and access to care; effective deployment of teams for planned transfers; a sustainable transport infrastructure to support the service and effective and timely communication with obstetric staff.

3.6.1 Timely Provision of Clinical Care

A high quality neonatal service will provide care at a time appropriate to clinical need with no unnecessary delays.

This will be evidenced by:

• The benefits of breastfeeding being highlighted at the earliest possible opportunity following delivery.
• The provision of clinical care and therapeutic interventions in line with current guidelines and timescales as specified by professional bodies, based on substantiated evidence.
• The adherence to standards and guidelines pertaining to national immunisation, national screening, neuro-developmental assessment and follow-up programmes.
• A named consultant making contact with the parents at an appropriate time to offer discussion and counselling following the death of a baby. This will take place no later than seven weeks following bereavement (unless instructed not to do so by the Procurator Fiscal).
• Transitional care being recognised as part of the full spectrum of neonatal care and being made available to parents, including those progressing from special care.

3.6.2 Emergency Transfer

A high quality service will provide a timely transfer for unscheduled cases.

This will be evidenced by:

• Delays in all types of transfers being captured in audit data at unit level. This will capture where there have been delays, highlight critical incidents and ascertain the reason for delays.
• The neonatal transport service liaising with the MCNs to initiate improvement programmes and work with transport teams to minimise delays in the future.

3.6.3 Non-emergency Transfer

A high quality service will provide an appropriately timed service for non-emergency transfers.

This will be evidenced by:

• Repatriation, or back transfer, being undertaken as soon as it is clinically appropriate for the baby.
• Where a baby is being returned to a unit following a surgical procedure, the surgical team ensuring timely communication with the unit concerning forthcoming transfer.

3.6.4 Transfer Guidelines

A high quality neonatal service will have guidelines in place for ex-utero transfers.

This will be evidenced by ex-utero transfer guidelines which cover:

• Referral processes.
• Indications and contra indications for transfer.
• Documentation of discussions between healthcare staff and women/parents/families undergoing transfer.
• Documentation of discussions between receiving and sending units.
• The written documentation of management prior to and during ex-utero transfers.

In-utero transfer guidelines will be in place to cover referral processes and documentation of discussions between receiving and sending units.

3.6.5 Communication with Obstetric Staff

A high quality service will ensure timely access to an appropriate level of care and expertise which results in the best possible outcome for neonates and their families.

This will be evidenced by:

• A structured communication process between neonatal and obstetric staff within the Networks.
• Regular case discussions taking place with the neonatologist, in units delivering obstetric care to high risk women and infants.
• The use of established channels of communication to share key information with the referring unit whilst the patient is still in the tertiary unit and after discharge, including death.