System & Process
The East Midlands Neonatal Operational Delivery Network (EMNODN) has clearly defined care pathways which have been agreed by the Clinicians, the Network Management Team and the Specialised Commissioning Team. It is important to monitor that these pathways are working effectively to ensure that each individual baby is cared for in the most appropriate unit.
BadgerNet includes an exception reporting component that can improve the Network’s management and understanding of pathway exceptions. The reports are based on key elements of the National Neonatal Critical Care Service Specification (E08) which define units as Neonatal Intensive Care Units (NICUs), Local Neonatal Units (LNUs), or Special Care Units (SCUs), and so may not mirror the currently agreed pathways for all the EMNODN services. However, it will be the Network Clinical Lead’s responsibility to filter the list prior to any local case review.
As well as the pathway exceptions generated by the BadgerNet report, units will be asked to review babies under 27 weeks born in an LNU or a SCU, failed repatriations, and inappropriate transfers. This will give an indication of demand pressures and other blocks to appropriate flow within the network.
A validated list of exceptions will be sent to the Neonatal Unit Service Leads quarterly. The units will complete and return an Exception Reporting Form for each exception, and these will be collated into a Network Exception Summary Report, which will be presented at each Clinical Governance Group meeting. This will provide the Clinical Governance Group and the Network Board with an accurate picture of pathway compliance and any reasons where non-compliance to Network pathways has been unavoidable. It will also provide contractual assurance to the Specialised Commissioning Team if required.
Local Neonatal Units and Special Care Units
Appropriate communication with the Lead Centre must be undertaken, and appropriate clinical advice given, if a baby is not transferred as per the agreed Network pathway. Feedback from the units will be required, in addition to the BadgerNet report, in order to generate a formal Network Exception Summary Report.
An Exception Reporting Form can be submitted by the units at the time the exception occurs, prior to the generation of the quarterly list of exceptions. These babies will be filtered out of the List of Exceptions sent to the unit.
At the time the exception takes place the clinical details around the exception should be completed and filed in the baby’s notes on an Exception Reporting Clinical Details Form. This document ensures there is appropriate governance around all discussions taking place between Lead Centres and LNU/SCU.
Leicester General Hospital
The Leicester Neonatal Service reports as one service but is delivered across two sites. It is not currently possible to extract an exception report for Leicester General Hospital (LGH). The process for monitoring exceptions at LGH will be reliant on self-reporting.
At the time that the exception takes place the clinical details around the exception should be completed and filed in the baby’s notes on an Exception Reporting Clinical Details Form. This document ensures there is appropriate governance around discussions taking place between Lead Centre and LNU/SCU.
Neonatal Intensive Care Units
To assist with monitoring capacity and demand within the Network for NICUs, the Network will generate a quarterly report of all NICU booked activity which has been delivered in a different unit. This will include all intensive care or surgical transfers out of Network from the Local Neonatal Units, and Special Care Units, which should have received care within the Lead Centre.
Exception reporting for babies born in a non NICU
An Exception Reporting Form will need to be completed for any baby born at less than 27 weeks in a LNU or SCU. This should be completed at the time of admission by the admitting neonatal team in collaboration with the obstetric team.
All babies should be repatriated to a unit which is as close to their home as possible, as soon as they are well enough to be transferred. An Exception Reporting Form should be completed if a baby is fit for transfer, but there is not a cot available within the required unit. This should also be marked on the Badger system as Ready for Transfer/Discharge, and documented within the baby’s medical notes. This is to enable the Network to develop an understanding of where there are capacity issues.
1. Appropriate BadgerNet access according to Network role:
- Anonomysed patient level data for the Network Data Analyst
- Read only access to clinical level data for the Network Clinical Leads – this will enable the BadgerNet report to be customised according to pathways
2. Two week turnaround for Neonatal Unit Service Leads to complete Exception Reporting Form around unit exceptions.
3. An Exception Reporting Clinical Details Form must be completed and filed in the baby’s notes where there has been a decision to deviate from the pathway. The presence of these forms in baby notes may be audited as required by the Network Team.