Exception Reporting
Exception Reporting
Forms
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. The pathways are based on key elements of the National Neonatal Critical Care Service Specification (2024) which define units as Neonatal Intensive Care Units (NICUs), Local Neonatal Units (LNUs), or Special Care Units (SCUs).
It is important to monitor that unit pathways are working effectively to ensure that each baby is cared for in the most appropriate unit. All care out of pathway should be reported to the network, using the exception reporting forms that can be found on the network website. For care out of pathway in LNUs and SCUs, appropriate discussion with the Lead Centre must be undertaken, and appropriate clinical advice given, if a baby is not transferred as per the agreed Network pathway.
BadgerNet includes an exception reporting component that can improve the Network’s management and understanding of pathway exceptions. The Badger report is a starting point, however some exceptions may be over-stated due to timings, eg a baby given CPAP from 10pm on one day to 2am the next will appear on the report as having had 2 days of CPAP, but has actually only received four hours. 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 failed repatriations, babies receiving care after the neonatal period, and babies admitted to the neonatal unit from a non-perinatal setting.
A validated list of exceptions will be sent to the Neonatal Unit Service Leads monthly. 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.
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.
Exception reporting for extreme preterm babies not born in a NICU
An Exception Reporting Form will need to be completed for any baby born extremely preterm in an LNU or SCU (extreme preterm is defined as a gestation under 27 weeks for singletons or under 28 weeks for multiple births; or a birthweight under 800g). The form should be completed at the time of admission by the admitting neonatal team, with a separate ‘obstetric reporting form’ completed by the obstetric team. Weekly checks will be done to ensure both neonatal and obstetric forms have been received, and units will be emailed to request any missing forms.
Repatriations
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.
Babies receiving care after the neonatal period
Generally speaking, babies should be not be an inpatient on the neonatal unit beyond 44 weeks, however the neonatal period covers the first four weeks of a babies life, so all babies requiring hospital care should be entitled to up to four weeks in a neonatal care setting. An Exception Reporting Form should be completed if:
a baby born at 40+0 weeks or below is still an inpatient at 44 weeks corrected gestational age; or
a baby born after 40+0 week is still an inpatient at four weeks of age.
Key Requirements
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 once a list of exceptions is received.
3. Where an item on the list of exceptions is due to a data input error, there will be a two-week turnaround for the unit to correct the error on Badger, and inform the Network Data Analyst so that records can be updated.