Embrace Annual Report
2015 - 2016
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Contents
1. Foreword ...... 3 2. Highlights 2015/16 ...... 4 3. The Embrace service ...... 6 Mission statement ...... 6 Background to Embrace ...... 7 Who we serve? ...... 7 What is the role of Embrace? ...... 8 Neonatal and paediatric transfer activity ...... 11 In-utero calls facilitated ...... 12 4. Embrace aeromedical service ...... 14 5. Feedback ...... 18 Parent feedback responses ...... 19 What the parents say about Embrace ...... 19 Sharing of feedback ...... 20 6. Clinical governance and quality improvement...... 21 Utilisation review ...... 21 Safety review meetings ...... 21 Clinical governance meetings ...... 21 Audit ...... 23 Completed & presented audit and service evaluation projects 2015/16 ...... 23 Mortality meetings ...... 25 Guidelines ...... 25 Research ...... 27 Oral presentations ...... 28 Poster presentations ...... 28 Lectures, presentations and academic ...... 30 International and national committees and working groups ...... 32 7. Education and training ...... 34 In-house Embrace education ...... 35 Outreach education ...... 35 Link nurse days ...... 36 8. Embrace in the news ...... 37 9. Work in progress for 2016/17...... 39 10. Appendices ...... 40 Appendix 1 ...... 40 Appendix 2 ...... 41 Appendix 3 ...... 42 Appendix 4 ...... 43
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1. Foreword
We are pleased to present the 2015/16 annual report for Embrace, Yorkshire & Humber Infant & Children’s Transport Service. Our 6th year of full operations saw us consolidating the progress made to embed a safety and quality culture. As well as having our 12 month progress report to the Commission on Accreditation of Medical Transport Systems accepted we became the first European service to submit data to the Ground and Air Medical qUality Transport (GAMUT) database. These two processes allow us to benchmark against similar neonatal and paediatric critical care transport services around the world as we strive to provide the highest quality care possible for our patients.
Cath Harrison, Lead Consultant (Neonates) Steve Hancock, Lead Consultant (Paediatrics) Suzanne Palmer, Interim Lead Nurse
3 2. Highlights 2015/16
Embrace received 3573 referrals and sent teams for 2191 transfers of infants and children across Yorkshire, the Humber and beyond
Embrace completed 35 helicopter and 7 fixed wing missions
Fully accredited by the Commission on Accreditation of Medical Transport Systems (www.camts.org) for critical care transport by ground, rotary wing and fixed wing
Continued successful CAMTS partnerships with Yorkshire Ambulance Service NHS Trust, Yorkshire Air Ambulance, The Children’s Air Ambulance and CEGA Air Ambulance
Full 12 month report from the Ground and Air Medical qUality Transport (GAMUT) database
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3. The Embrace service
Embrace Yorkshire & Humber Infant & Children’s Transport Service has been operational since 6th December 2009. The service meets the standards set by the UK Paediatric Intensive Care Society1, the National Institute for Health and Clinical Excellence Specialist Neonatal Care Quality Standard2 and the Commission on Accreditation of Medical Transport Systems3 for the provision of specialist transport services by ground and air.
The host organisation for Embrace is Sheffield Children’s NHS Foundation Trust - one of only 4 independent children’s Trusts in the UK.
Mission statement
Embrace aims to provide the highest quality paediatric and neonatal care for infants, children and their families from the first point of contact to arrival at the destination unit.
It is the mission of Embrace to provide:
A single point of telephone contact for referring clinicians Access to immediate specialist clinical advice Triage to an appropriate level of transport provision and dispatch of transport teams within a clinically appropriate time window Identification of a suitable cot or bed so that the most appropriate care is provided in the most appropriate location for any infant or child requiring specialist care in the Yorkshire & Humber region Logistical support for high risk obstetric transfers by locating a suitable maternal bed and neonatal cot
1 th PICS Quality Standards for the Care of Critically Ill Children 5 Edition. Paediatric Intensive Care Society; 2016 2 Specialist Neonatal Care Quality Standard. National Institute for Health and Clinical Excellence; 2010 3 Commission on Accreditation of Medical Transport Systems standards 9th Ed www.camts.org
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To achieve this Embrace will:
Maintain appropriate communication between all parties to ensure the efficient and effective continuity of patient care Ensure every transfer is carried out in a way that maximises patient safety, comfort and dignity and minimises patient pain, discomfort, or distress and that of parents/guardians
Background to Embrace
Embrace provides specialised transport for all newborn infants and critically ill children from Yorkshire and the Humber who need moving between hospitals. The aim is to provide this service at the right time while providing the same high standards of care that they would receive in a specialist hospital. The vision was for a service separate from the receiving and referring hospital, enabling the team to be available on demand for the transfer of a critically ill infant or child. The service was founded on co-operation and collaboration between all parts of the Yorkshire & Humber NHS and this spirit has been fundamental to the continued success and growth of the service.
Embrace is part of the Surgery & Critical Care Division at Sheffield Children’s NHS Foundation Trust which includes Paediatric Intensive Care, High Dependency Care, Neonatal Surgery, Paediatric Anaesthesia, Theatres and the Pain Service. Working within a Division that specialises on the delivery of critical care to patients has allowed Embrace to develop strong clinical governance structures focussing on safety and quality.
Who we serve?
Embrace serves the children of Yorkshire and the Humber region which covers an area of 15,400 square kilometres, has a population of 5.3 million, of which 17% are aged under 16 years, and an annual live birth rate of approximately 75,000. The community includes large urban settlements such as Hull, Leeds and Sheffield as well as rural
7 areas such as the East Riding of Yorkshire and North Yorkshire. We transfer newborn infants and critically ill children to and from the hospitals operated by the acute NHS Trusts in the region:
Airedale NHS Foundation Trust Barnsley Hospital NHS Foundation Trust Bradford Teaching Hospitals NHS Foundation Trust Calderdale and Huddersfield NHS Foundation Trust Doncaster and Bassetlaw Hospitals NHS Foundation Trust Harrogate and District NHS Foundation Trust Hull and East Yorkshire Hospitals NHS Trust Leeds Teaching Hospitals NHS Trust The Mid Yorkshire Hospitals NHS Trust Northern Lincolnshire and Goole Hospitals NHS Foundation Trust Rotherham NHS Foundation Trust Sheffield Children’s NHS Foundation Trust Sheffield Teaching Hospitals NHS Foundation Trust York Teaching Hospitals NHS Foundation Trust
What is the role of Embrace?
Most infants and children can be cared for close to home in their local hospitals, however there are some for whom this is not possible. Embrace provides a single point of contact by which clinicians caring for these infants and children can access regional services, get advice and arrange transfers.
A single phone number puts the clinician through to a call handler who takes some basic information before bringing in one of our specialist transport consultants. As more details are obtained a picture of the infant or child is put together. Other specialists, such as neonatologist, cardiologists or intensive care physicians, can be ‘conferenced’ into the call by the call handler as required. Together these clinicians can make a plan for the care of the infant or child. All calls are recorded and these recordings form part of the clinical records.
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When a plan involves moving the infant or child to more specialist care, the transport consultant and nurse co-ordinator decide upon the makeup of the transport team to provide the best possible care during the journey. This will depend on the level of critical care that the infant or child requires. The sickest children would have a team consisting of a transport consultant, middle grade doctor or Advanced Nurse Practitioner working with a transport nurse and ambulance driver; a more routine transfer may involve a transport nurse and a driver.
On arrival at the referring hospital the Embrace team take a handover from the referring team before assessing the child. The child can be moved onto the transport equipment once the team are satisfied that the patient is stable. The journey can then begin. Wherever possible, Embrace encourages a parent to accompany their child during the journey. On arrival at the destination hospital the child is handed over to the receiving team and moved from the transport trolley into an appropriate bed or cot for their ongoing care. Once the transfer has been completed the Embrace team will liaise with the base to determine the next task to be completed.
Air transport is provided in collaboration with specialist partners, by either fixed wing or rotary wing.
Regular feedback from the referring and receiving hospital teams as well as parents has enabled Embrace to be responsive to the needs of those it serves and to modify our service.
9 Activity 2015/16
During the report period Embrace took 3572 referrals which resulted in 2191 neonatal/paediatric transfers and 535 in-utero transfers.
The following graphs and tables show this activity in greater detail.
Embrace Activity Consolidated Apr- May- Jun- Jul- Aug- Sep- Oct- Nov- Dec- Jan- Feb- Mar- Year to date activity 15 15 15 15 15 15 15 15 15 16 16 16 Referrals 260 338 327 304 287 254 302 290 346 295 274 295 3573
Paediatric Transfers 42 49 43 37 32 27 47 51 75 74 59 47 583 Neonatal Transfers 105 160 167 134 153 143 137 128 132 115 120 114 1608 Total Transfers 147 209 210 171 185 170 184 179 207 189 179 161 2191
Advice Calls 49 56 44 59 44 47 57 52 69 51 43 64 635 In-utero transfers 47 60 54 61 46 26 36 36 40 34 40 55 535 facilitated Non Embrace 17 13 19 14 12 11 25 23 30 21 12 15 212 transfers
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Neonatal and paediatric transfer activity
The following table shows the break down between neonatal and paediatric work compared between 2014/15 and 2015/16, with further break down between in utero and advice calls.
Embrace activity comparison Total Total referrals 2014/15 3312 Total referrals 2015/16 3573 Embrace paediatric transfers 2014/15 543 Embrace paediatric transfers 2015/16 583 Embrace neonatal transfers 2014/15 1581 Embrace neonatal transfers 2015/16 1608 Embrace total transfers 2014/15 2124 Embrace total transfers 2015/16 2191 No transfer/advice 2014/15 600 No transfer/advice 2015/16 635 In utero transfers facilitated 2014/15 372 In utero transfers facilitated 2015/16 535 Other transfers 2014/15 216 Other transfers 2015/16 212
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Activity difference 2014/15-2015/16 No % Diff Total referrals 260 8% Embrace paediatric transfers 40 7% Embrace neonatal transfers 26 2% Embrace total transfers 66 3% No transfer/advice 35 6% In utero transfers facilitated 163 44% Other transfers -4 -2%
12 In-utero calls facilitated
Part of Embrace’s role is to provide an in-utero bed finding service and facilitate the obstetrician to obstetrician discussions. The following table and graph show activity handled by the call centre team. IUT Activity with comparison between 2014/15 and 2015/16
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar IUT Activity 33 35 30 27 27 21 21 28 25 27 25 34 2014/15 Facilitated IUT Activity 45 30 45 45 37 34 46 42 26 41 27 24 2015/16 Facilitated
50 In-Utero Activity 2015/16
45 IUT Activity 40 2014/15 Facilitated 35 IUT Activity 30 2015/16 Facilitated 25
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10
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0 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
13 4. Embrace aeromedical service
2015/16 was a period of consolidation in the aeromedical service that Embrace provides. The philosophy is to ensure that our patients have access to the best form of transport depending on clinical condition, distance, weather and logistics. This will often be a road ambulance, but may be a fixed wing aircraft or helicopter.
Embrace are the biggest provider of inter-hospital aeromedical transport in England.
Working with our partners we are able to provide a comprehensive NHS service and have developed the capability to transfer ventilated patients on multiple infusions and nitric oxide by fixed wing aircraft (CEGA Air Ambulance4 and IAS Medical5) and by helicopter (The Children’s Air Ambulance6). The important relationship with our local HEMS service (Yorkshire Air Ambulance7) continued, allowing us to get specialist teams and equipment out to the patient’s bedside at our more distant hospitals. When working with CEGA, TCAA and YAA we are fully accredited by the Commission on Accreditation of Medical Transport Systems.
In 2015/16 Embrace transferred 7 patients by fixed wing aircraft and 35 patients by helicopter. In addition we used a helicopter to fly an Embrace team and equipment to 8 critically ill patients. Please see Appendix 1 for a detailed utilisation review.
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2015 saw the handover of search and rescue services from the military to a private contractor, Bristow helicopters. From September 2015 Embrace had access to a new state-of-the-art helicopter based at Humberside airport. This provides us with valuable resilience for when our usual air providers are not available or not able to fly. In 2015/16 we utilised Bristow three times for patients who were likely to be compromised by a long road journey.
Five of the seven fixed wing flights involved moving patients into England from foreign destinations. For the first time an Embrace team crossed the Atlantic and transferred a patient from Canada, a complex logistical exercise which pushed our organisation and logistical skills to the limit, but which had a successful outcome.
We were sad to see the end of fixed wing flights with CEGA Group in early 2016, as they sold their aircraft to focus on other aspects of the medical assistance business. We are pleased to be able to continue to offer a fixed wing service in partnership with IAS Medical, who are based at Teeside airport.
As a result of this change we lost our CAMTS fixed wing accreditation but are working with IAS Medical to regain this in 2017. Embrace are now able to safely transfer patients in fixed wing aircraft who require inhaled humidified gases, thanks to a generous gift of specialist equipment from the hospital charity. We are currently the only transport service in England to offer this service.
We flew 32 patients with The Children’s Air Ambulance in 2015/16, more than any other service in the country. This service continues to be limited to daylight hours on weekdays and we look forward to TCAA's exciting plans to develop their service by adding an additional aircraft, increasing operating hours and upgrading their fleet to larger, more modern helicopters.
The lack of an appropriate air-compatible incubator continues to hamper our operations and Embrace have been advocating with NHS England for support in filling this gap in provision. This will hopefully be an exciting project for Embrace in 2017, working alongside our aircraft providers.
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The important relationship with our local HEMS service (Yorkshire Air Ambulance7) continued, allowing us to get specialist teams and equipment out to the patient’s bedside at our more distant hospitals. Development of aeromedical work in Yorkshire continues to be limited by a lack of suitable landing sites. We are desperately in need of upgraded helipad facilities in many of our referring and receiving hospitals.
Night of Flight:
The 7th Night of Flight was in July 2015. There were speakers from all across the region, and also guest presenters from transport services in the North West and Wales. The format continues to be a successful way of sharing our air experience with others and celebrating our successes. It is also a valuable opportunity to relax and enjoy food and conversation with our stakeholders and partners.
4 www.cega-air-ambulance.com/ 5 www.iasmedical.com 6 www.thechildrensairambulance.org.ok 7 www.yorkshireairambulance.org.uk
Fixed wing flights
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Rotary flights
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5. Feedback
Since Embrace was first established we have invited feedback from stakeholders including patients, parents and referring/receiving hospital staff.
Embracing parents
Embrace aims to offer one parent the opportunity to travel with their baby/child. Parent’s views of the service are collected throughout the year using an anonymous feedback form. Parents are also able to email their feedback regarding their experience.
The table below show the results from our parental feedback work. Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
Referrals 260 338 327 304 287 254 302 290 346 295 274 295 Paediatric Transfers 42 49 43 37 32 27 47 51 75 74 59 47 Neonatal Transfers 105 160 167 134 153 143 137 128 132 115 120 114 Total Transfers 147 209 210 171 185 170 184 179 207 189 179 161 Forms Distributed 72 104 92 99 103 108 95 80 95 83 123 95 Forms Returned 13 8 12 8 18 19 16 8 15 13 9 23 Distribution Rate 49% 50% 44% 58% 56% 64% 52% 45% 46% 44% 69% 59%
Response Rate 18% 8% 13% 8% 17% 18% 17% 10% 16% 16% 7% 24% Overall Response Rate 9% 4% 6% 5% 10% 11% 9% 5% 7% 7% 5% 14%
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Parent feedback responses
What the parents say about Embrace
“Great service. We wouldn’t have been able to go home with our twin babies if it wasn’t for embrace transferring us from one hospital to our home hospital. Fabulous professional service. Can’t fault the staff.”
“My partner and I would like to thank the Embrace team. Thank you doesn’t really begin to explain how appreciative we are for the truly amazing service you provided for us and our beautiful baby boy who was born 11 weeks early at X hospital. He needed life-saving surgery when the Embrace team arrived to transport him to Y. We were absolutely distraught at the time and the team members were so kind and considerate towards us. He really was in safe hands and he got to Hull just in time. The Embrace team played a major part in saving our little boy’s life and for that we will be forever grateful. Thank you so, so much, you really are amazing.”
“Fantastic work from the Embrace team. Made the whole experience pleasant as I was very worried, great to have a cheerful nurse.”
“Our baby has been transported by Embrace 5 times and the staff have always been exceptional. We will never be able to thank Embrace enough. We have since seen some of the staff in the hospital and they have taken the time to see our baby and speak with us which has been lovely. Thank you so much again.”
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Sharing of feedback
Parent feedback is reported quarterly to the Embrace Reference Group. In addition, the feedback and learning points are shared with Embrace staff and link nurses from across Yorkshire & Humber. Embrace have established links with the Patient Advice and Liaison Service (PALS) at SC(NHS)FT for parents who may wish for Embrace to provide a formal response.
20 6. Clinical governance and quality improvement
Embrace has a robust clinical governance structure focussed on safety and quality. We continue to work towards reaccreditation for critical care transport by ground, fixed wing and rotary wing due in July 2017 from the Commission on Accreditation of Medical Transport Systems (www.camts.org).
Utilisation review
All referrals and transfers are reviewed the day after by a consultant to identify any issues that needs urgent action or clarification. Safety reports are completed and a trigger list flags up cases for more detailed analysis in a multi-professional forum.
Safety review meetings
Incident reports can be filled in by any member of the team and an open, just culture is promoted. All reports are initially reviewed by the Lead Nurse, acting as the Safety Officer and an appropriate action plan made. There is follow-up on the results of actions for all events at the monthly Safety Review Meeting to ensure loop closure is achieved. A summary is presented at the monthly Clinical Governance meetings.
The reports are also reviewed weekly by the SC(NHS)FT incident grading group. Any re-grading, clarifications and further action points are communicated back to Embrace. Embrace is represented at the monthly Divisional Risk meeting.
Clinical governance meetings
Monthly minuted meetings chaired by the governance lead occur with representation from every staff group (medical, nursing, call handling and drivers). The meeting covers quality improvement, audit, service evaluation, guideline development, risk management, safety and equipment.
Our service partners also attend Embrace governance meetings on a rotational basis.
21 Quality improvement Embrace continues to submit data to three benchmarking organisations to help drive quality improvement. Links to the reports from these organisations can be found at www.embrace.sch.nhs.uk a) Paediatric Intensive Care Audit Network (PICANet) Every PICU and paediatric transport team in the UK and Eire submit quality data to this national organisation which publishes an annual report. b) Neonatal Transport Group (NTG) The UK Neonatal Transport Group collates data from every neonatal transport team in the UK over a 6 month period January to June every year. The annual returns are presented to allow comparison data and benchmarking relating to activity, key performance indicators and service provision. c) Ground and Air Medical qUality Transport (GAMUT) GAMUT is a US based database which tracks, reports and analyses performance on key transport specific quality metrics allowing comparison with other teams. Metrics apply to adult, paediatric and neonatal transport. It is hosted by Cincinnati Children’s Hospital with support from the Air Medical Physicians Association (AMPA) and the American Academy of Pediatrics Section on Transport Medicine. Embrace began submitting data in January 2015, the first transport service in Europe to do so.
Regional meetings There is Embrace representation by a member of the consultant team at regional clinical expert groups and strategy group meetings. These include trauma, surgery, anaesthesia, paediatrics, critical care, neonatology and maternity services.
Embrace sit on the Neonatal ODN and Paediatric Critical Care ODN executive boards, as well as being represented at clinical forums.
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Audit
All staff groups are encouraged to be involved in audit projects. Most Specialist Trainees carry out an audit project in their 6 month placement supervised by a consultant. Projects are registered through the Clinical Governance Department at SC(NHS)FT.
The majority of audits have resulted in changes to our practice and have been presented at local, regional and international meetings.
Completed & presented audit and service evaluation projects 2015/16
Level 1 Rolling projects
Deep cleaning compliance audit J Dive
NHSLA clinical record keeping S Palmer
PICANet F Rajah
23 Level 2 Trust/commissioned projects
Parental views of transport service L Kay, J Hervo
Outreach Time Critical Transfer Training S Sandhu, S Hancock
Questionnaire for referring and receiving hospitals J Sharpe
Level 3 National Accreditation projects
National Neonatal Transport Group (NTG) annual data return C Harrison, S Hancock, F Rajah, R Trent
National Neonatal Transport Group (NTG) Prospective survey of infants transferred for assessment and management of bilious vomiting in the first 7 days of life K Spinks
Level 4 Clinician and Divisional Interest
Audit of burn pathway R Cronin
Lights and sirens B Basu
Management of children with DKA U Niranjan
Use of therapeutic hypothermia in newborns with HIE A Manou
Embrace abandoned transfers U Majuran
Never events and near misses C Halton
Children with cardiomyopathy transferred by Embrace A Kelly, F Rajah
Evaluation of advice calls to Embrace R Riddell
24 Mortality meetings
Embrace have monthly internal mortality review meetings. We also attend mortality & morbidity meetings in hospitals around our region when Embrace has been involved in the care of the infant or child. These are invaluable in developing relationships between Embrace and referring and receiving units and help to encourage a learning environment. Embrace also sit on regional ODN mortality review panels.
Guidelines
Guideline development is managed through a quarterly Guideline Group meeting. Completed guidelines and standard operating procedures are ratified through the SC(NHS)FT Clinical Effectiveness and Audit Committee. Guidelines are available on SC(NHS)FT intranet and relevant guidelines are also available publicly on the Embrace website www.embrace.sch.nhs.uk
New guidelines 2015/16:
Embrace Stabilisation & Transfer of Infants with Congenital Diaphragmatic Hernia
Embrace Transportation & Storage of Expressed Breast Milk during Transfer Guideline
Requesting and Utilising a MoD/Coastguard Resource for Aeromedical Transfer – Search and Rescue (SAR) Guideline
Reviewed guidelines/protocols 2015/16
Guideline for Staff – Parents Travelling in Embrace Ambulance
Guideline for Palliative Care Transfers
Regional Guideline on Use of Alprostadil in Duct Dependent Congenital Heart Conditions in Neonates Embrace Airway Humidity Guideline
Embrace Guideline for Stopping Feeds on Neonatal Patients prior to Transfer Corneal Abrasion Prevention Strategy in Transport Guideline
25 Preparing a Patient for a Time Critical One-Way Transfer by the Referring Hospital team
Preparing a Neonatal Patient for Emergency Transfer Preparing a Paediatric Patient for Emergency Transfer
Collapse or Death of an Infant During Transfer Embrace Guideline for Nurse Delivered Transfers
Management of Diabetic Ketoacidosis during the Transfer Process Embrace Guideline for the Actions in the Event of Ambulance Breakdown or Road Traffic Collision (RTC)
Embrace High Flow Therapy for Neonates during Transfer Guideline
Acute Asthma Management Guideline for Infants Greater than 2 years Old Embrace In-Utero Transfers (Yorkshire) Guideline
Embrace Documentation Standards Embrace Mobile Phone Guideline
Embrace Health & Safety in Transport Guideline Management of Upper Gastro-Intestinal Bleeding in Children Guidance: A Transport Team Perspective (Embrace) Managing the Transfer of Neonates Born at Northern General Hospital (NGH), Sheffield Safety Management System (Embrace)
Embrace Observers Guidance Embrace Temperature Control Guideline
Embrace Call Centre & Administration Standard Operating Procedure Embrace Administration of Blood or Blood Components during Transfer
Embrace Hazardous Materials Guideline Fatigue Management Guidance (Embrace)
Embrace Drivers Standard Operating Procedure
Provision of Pre-Hospital Care by Embrace Transport team at Scene of a Road Traffic Collision (RTC) or Unexpected Roadside Incident Standard Operating Procedures - Aeromedical Transport Guideline Requesting and Utilising Fixed Wing Resource for Aeromedical Transfer – Fixed Wing Guideline
26 Requesting and Utilising a TCAA Resource for Aeromedical Transfer – ‘TCAA Guideline’
Requesting and Utilising Yorkshire Air Ambulance for Medical Passenger Transfer – ‘YAA Guideline’
Embrace Transport Service Visitors Local Procedure Yorkshire and Humber ODN (South) Network Clinical Guidelines – CPAP (Continuous Positive Airway Pressure) Yorkshire and Humber ODN Pan Network Clinical Guideline – Management of Hypoxic Ischaemic Encephalopathy Including Total Body Cooling
Embrace Prescription Chart
Operational Policies and Clinical Guidelines for Referral and Stabilisation of Neonates Requiring Critical Care within Yorkshire and Humber (2014 Edition)
Oxylog Training Pack Protocol for the Administration of Oral Sucrose for Procedural Pain in Neonates and Infants (up to 1 year old) Embrace Documentation Standards
Research
Embrace promote a research culture and have encouraged the multi-professional team to collaborate on projects. A number of papers have been presented and published during 2015/16.
Publications
Postnatal care: a neonatal perspective (NICE guideline CG 37) N Holme, L Boullier, C Harrison Arch Dis Child Educ Pract Ed doi:10.1136; Nov 2015
Referral and transfer of the critically ill child D Gilpin, SW Hancock BJA Ed; Nov 2015
27 Embrace - 5 years on C Harrison Infant, 2015; 11:6
The burden and outcome of in utero transfers R Musson, C Harrison Acta Paediatrica 2015; 105 (1); 1-4
Air Medical Transport in the UK SW Hancock, I Braithwaite Principles and Direction of Air Medical Transport 2nd ed
Oral presentations
Annual Paediatric Intensive Care Society (PICS) Conference, Birmingham, September 2015
Time series peripheral white cell differential gene expression in children with meningococcal sepsis A Rashid
26th Annual Meeting of the European Society of Paediatric and Neonatal Intensive care, Vilnius, Lithuania; June 2015
Do you need a doctor? - Advanced nurse practitioner lead transfers in a combined neonatal and paediatric transfer team J Longden and F Rajah
6th International Pediatric Simulation Symposium and Workshops, Vancouver; May 2015
Engaging non-clinical staff in transport simulations of the critically ill infant & child – are they part of the team? R Trent
Identifying Latent Risks Through In-Situ Simulation Training to Improve Patient Safety S Sandhu
Poster presentations
Retrieval April 2015
Collaboration between a helicopter emergency service and a regional specialist children’s transport service I Braithwaite, L Crabtree, S Hancock, S Wills
28 EPNCIC 2015 Congress, Montreux, Switzerland
Children with a New Diagnosis of Cardiomyopathy Transferred by Embrace Transport, Yorkshire and Humber Infant and Children’s Transport Service A Kelly, F Rajah
Neonatal Transport Group Annual Conference, Brighton; November 2015
Team directed fatigue, health and wellbeing R Kent, J Butler
Palliative care transfers – the first 6 years of Embrace S Hands, C Harrison
Effectiveness of the nurse-led transfer guideline K Spinks
Unintended neonatal hypothermia C Vas
Development of E-MAP for complex patients E Richardson, S Courtney, C Howard, J Oldfield
Royal College of Paediatrics Annual Meeting, Birmingham; April 2015
Is the Neonatal Life Support course really that stressful? An observational study N Holme, C Harrison, N Shaw
‘Value of Values’ in Health and Social Care Leadership Conference, Sheffield Hallam University; September 2015
Quality improvement in the care of critically ill children by Embrace C Vas
29 Lectures, presentations and academic
Cath Harrison
To tube or not to tube North West Neonatal and Paediatric Transport Services Annual Governance Day; October 2015
The neonatal training pathway British Association of Perinatal Medicine Trainees Day, London; October 2015
Non Invasive ventilation Stabilisation of the preterm baby Recognition and stabilisation of the surgical baby Royal College of Paediatrics and Child Health, Progressing Paediatrics Day, York; October 2015 Organiser and speaker
High risk neonatal transfers Neonatal Transport Group Annual Conference, Brighton; November 2015
Embrace - 5 years on and the future Yorkshire and Humber Neonatal ODN meeting; November 2015
The Shape of training - the future for neonatology National Neonatal Discussion Forum, Monmouth; February 2016
Steve Hancock
Paediatric transport Leicester Paediatric Anaesthesia Meeting, Loughborough; October 2015
Children’s emergency rescue Harbury NSPCC Ladies Lunch; October 2015
Difficult paediatric airways Air Medical Transport Conference, Long Beach California; October 2015
Children’s emergency rescue Royal Medical Benevolent Fund (Warwickshire) Annual Dinner; November 2015
Paediatric critical care in the ED – the ‘Golden Hour’ plus The Royal College of Emergency Medicine Spring CPD Conference; March 2016
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Jess Oldfield
Medical students’ master-class Embrace; April 2015
Difficult airways in transport Yorkshire Paediatric Anaesthetic Network Meeting; June 2015
Karen Spinks
Transferring patients by air: The differences between adults and paediatrics CEGA, Bournemouth; September 2015
An insight in to the Embrace Transport Service NeoSAVE course, Sheffield; October 2015
Intensive care of the newborn degree module study day Embrace; November 2015
Ian Braithwaite
Development of a new electronic whiteboard and mapping the activation process In collaboration with Sheffield Hallam University
Ray Trent
The Work of Embrace Transport Service South Yorkshire Federation of Women's Institutes, Dodworth St Mary's Mother's Union, Wombwell Birchencliffe St Philip's Mother's Union, Huddersfield Staincross Ladies Group, Barnsley
Speaker on Community Education Programmes Barnsley College, Health & Social Care Course Barnsley University
31 Inspire the future, promoted by SCH(NHS) FT
Norfolk Park Community Primary School Penistone Grammar School Woodsetts Primary School
International and national committees and working groups
Suzanne Palmer UK Neonatal Transport Group PICS Nurse Manager’s Group
Steve Hancock International Pediatric Simulation Society (IPSS) Education Committee PICS Acute Transport Group ALSG NAPSTaR course working group member Scottish Specialist Transport and Retrieval (SCOTSTaR) Advisory Group Air Medical Physicians Association (AMPA) Membership Committee chair Board Member (AMPA representative) Commission on Accreditation of Medical Transport Systems - Europe
Cath Harrison Chair of UK Neonatology College Specialty Advisor Committee for RCPCH UK Neonatal Transport Group member UK NTG Air group member Member of RCPCH Invited Review Panel for UK Lecturer for RCPCH Improving Paediatrics study days Lead Neonatologist for Birthlink charity Management Board Member for LTHT charity, Optin NLS Course Director – Rotherham, Leeds, Gibraltar CESR advisor for GMC Editorial Board, Infant Journal
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Abi Hoyle Paediatric Training Lead for the Defence Medical Services Deployed Paediatrics Special Interest Group (DEPSIG)
Fatemah Rajah Embrace PICANet representative RCPCH ST3/ST4 interview panel member
Cath Smith NLS Course Director
Ian Braithwaite Chair The Children’s Air Ambulance Equipment User Group DoH Nitric Oxide Tender Expert Group representative
Claire McLean DoH Nitric Oxide Tender Expert Group representative
Jenny Longden Programme Lead for MMedSci Advanced Paediatric Nurse Practitioner Course, University of Sheffield
33 7. Education and training
The on-going education and development of all team members remains a priority for Embrace. To achieve this goal the education team have developed an education plan reflecting SC(NHS)FT, PICS, NTG and CAMTS guidance to achieve local national and international standards.
This has been a year of change for the education team as Claire Howard who worked for Embrace from its development has taken on the role of lead nurse for Neonatal Surgical Unit at SCH. Jo Whiston continues in her role and has welcomed Ian Braithwaite and Jenny Ashley to the team.
The education plan has been delivered at both a trust level in mandatory training sessions and by the Embrace education team. During 2015/16 Dr Christopher Vas and Dr Bob Basu have strengthened the team in their roles as Health Education Yorkshire & Humber Leadership Fellows with a focus on service evaluation of key performance indicators for quality improvement.
34 In-house Embrace education
A continued focus for the education team has been to maintain the requirements to achieve the CAMTS accreditation. Clinical procedures highlighting high risk, low frequency events remain a key part of the education plan to maintain high standards of knowledge and skills throughout the Embrace team.
The Crisis Resource Management (CRM) courses have been utilised to reinforce key standard operating procedures and develop team situational awareness and communication.
Our competency document has been revised and updated to incorporate both neonatal and paediatric national standards. Rotating Specialist Trainees all completed the new competency document, attended the SC(NHS)FT induction for medical staff as well as a two week induction programme at Embrace combining theoretical knowledge and practical skills and scenarios training and testing.
We had two new nurses start at Embrace who also completed the competency package, and attended both neonatal and paediatric resuscitation courses. They had a supernumerary period of transition from observer to independent practitioner.
Outreach education
Members of the Embrace team from all disciplines have delivered regional outreach education in the form of talks, small group teaching, in situ simulation and OSCE’s covering the Embrace process, reviewing data and clinical cases. We have had an increasing number of observers visit and accompany the transport team from nursing specialities, anaesthesia, emergency medicine, neonatal and paediatric backgrounds.
Members of the Embrace team also provide their time and expertise to teach on accredited life support and resuscitation courses regionally, nationally and internationally.
35 European Paediatric Life Support (EPLS) Advanced Paediatric Life Support (APLS) Neonatal Life Support (NLS) Advanced Trauma Life Support (ATLS) Paediatric and Infant Critical Care Transport (PICCTS) Paediatric and Neonatal Safe Transport and Retrieval (PaNSTaR) Sheffield Children’s Advanced Trauma (CAT) Generic Instructor Course (GIC)
Embrace continues to work closely with the Neonatal and Paediatric Operational Delivery Networks to assist with the delivery of regional training relating to transport. We have delivered 8 time critical insitu simulation courses over the year. The aim is to assist local hospitals deliver time critical transfers, reflecting on clinical skills equipment procedures and guidelines. This has evaluated positively and we aim to continue delivering this across the network.
Link nurse days
We held three link nurse days over the year providing a platform for education and discussion for all nurses involved with resuscitation, stabilisation and transfer of neonates and children. These were well attended and are an ideal way to share information and learn. The days also provide a forum for clinical governance issues to be discussed and allow direct feedback to Embrace to help develop our service.
36 8. Embrace in the news
April 2015
York Press
The stories of Isabella and Layla, who both benefited from Embrace’s expertise were celebrated in a double story.
Isabella’s dad, Dad, Grant, said: “Without the Embrace service, Bella may not have been with us today.”
Layla’s mum Kat said: “The Embrace team spent a long time doing everything they could to get her ready for the journey.”
Worksop Guardian
Football rivalry renewed as family aim to raise £20k to repay Embrace and Sheffield Children’s Hospital for ‘wonderful care’ when seven-year-old son passed away.
Sheffield Star Paramedics save boy, 10, who had heart attack at South Yorkshire school Mum Joanne Hodder said: “I cannot thank each and every person who played a part in saving Koby’s life and helped with his recovery enough. Teachers, paramedics, hospital staff and Embrace Children’s Transport Service have all been amazing.
May 2015
York Press After being born prematurely, baby Kyle had three holes in his heart repaired by surgery – his parents promised to raise money for Embrace.
37 July 2015
York Press “I can’t thank everyone enough.” – Brave mum of Kyle who passed away in July thanks all involved in his care. Kyle was transferred in May and featured in news stories when he returned home, but sadly passed away in July of 2015.
October 2015
Yorkshire Post, South Yorkshire Times Restart a Heart day – Embrace staff take part in CPR training for hundreds of children.
Yorkshire Post, Batley News Finley Blakeley celebrates his first birthday by re-visiting the Embrace team that helped save his life.
February 2016
Huddersfield Examiner Mirfield couple say thanks for baby Louie's care – The four week old suffered a dangerous bout of bronchitis and was transferred between Calderdale and Sheffield hospitals.
March 2016
Scottish Daily Record and Yorkshire Post Little Alistair was flown all the way to Leeds from Scotland after being born prematurely – he became an honorary Scot!
BBC News, Helicopter Investor, Third Sector news Libor fines to be used to fund extra helicopter for Children’s Air Ambulance, a partner organisation working with Embrace
38 9. Work in progress for 2016/17
A number of projects are underway at Embrace for the year 2016/17
Working towards our CAMTS reaccreditation in July 2017
Introducing a new database which will allow national key performance indicators
and other data points to be fed directly into national audit projects
Increased research involvement with University colleagues, other transport
teams and national programmes
Analysis of the Ground and Air Medical Transport qUality Transport (GAMUT)
data to assess potential improvements in the service
39 10. Appendices
Appendix 1
Embrace aeromedical utilisation data 2015/16
Neonatal Neonatal Paediatric Paediatric 2015 - 2016 Totals Team Patient Team Patient
Type Repatriation 15 9 24 Planned 3 0 3 Emergency 5 3 3 12 23 50 Acuity Low dependency 14 6 20 High dependency 2 6 8 Intensive Care 5 5 3 9 22 50 Reason Cardiac 1 1 7 9 ENT/Airway 1 1 Haem/Onc 1 1 Liver 1 1 Neurology 1 1 1 3 Neurosurgery 1 1 Post Treatment Return 15 9 24 Prematurity 1 1 Respiratory 1 2 3 6 Sepsis 1 1 Surgical 2 2 50 Mode Rotary 5 21 3 14 43 Fixed Wing 2 5 7 50
Operator YAA SAR TCAA CEGA IAS Total
2014/15 12 0 25 7 3 47 2015/16 8 3 32 6 1 50
40 Appendix 2 Embrace organisational chart and team profile
Associate Clinical Director Locality Director Emergency Operations Surgery & Critical Care Division SC(NHS)FT Yorkshire Ambulance Service
Associate Director Surgery & Locality Manager Yorkshire Critical Care Division Ambulance Service SC(NHS)FT
Trust Medical Lead Paediatric Critical Care & Embrace Clinical Nurse Manager Paediatric Critical Care & Embrace
Embrace Lead Embrace Transport Embrace Transport Nurse Consultant (Paediatric lead) Consultant (Neonatal lead)
Embrace Embrace Advanced Embrace Band Embrace Call Consultants Nurse Practitioners 7 & 6 Nurses Centre Manager
Embrace Specialist Embrace Call Embrace Trainees Handlers Ambulance Drivers
Associate Clinical Director Surgery & Critical Care Division SC(NHS)FT – Mr Prasad Godbole
Associate Director Surgery & Critical Care Division SC(NHS)FT – Jim Butler
Trust Medical Lead, Paediatric Critical Care Unit & Embrace – Dr Jeff Perring / Cliff Bevan (from April 2015)
Clinical Nurse Manager, Paediatric Critical Care & Embrace – Claire Harness
Embrace Lead Nurse – Suzanne Palmer
Embrace Lead Consultant (Neonates) – Dr Cath Harrison
Embrace Lead Consultant (Paediatrics) – Dr Steve Hancock
Locality Director South CBU – Jackie Cole
Locality Manager YAS – Andrew Flavell
41 Appendix 3 Embrace staff profile
The Embrace team that delivers this front line service consists of:-
Consultants from specialist backgrounds in Paediatric and Neonatal Critical Care who are skilled and experienced in managing the medical care of very sick infants and children
Specialist Trainee doctors who rotate from the regional paediatric rota; these doctors bring with them general paediatric experience and they leave with enhanced skills in triage, leadership, stabilisation and transfer to take back to the regional hospitals
Nursing staff who have come from both neonatal and paediatric critical care backgrounds so have vast skills and experience in caring for critically ill babies & children
Call handlers and a call centre manager to ensure that the telecommunications system runs smoothly; the call handlers provide a professional and reassuring first point of contact
Yorkshire Ambulance Service (YAS) drivers; Embrace is an integrated team and the drivers play a key part ensuring the transfers are safe and efficient
42 Appendix 4 Embrace staff list 2015/16
Consultants Dr Steve Hancock Dr Cath Harrison Dr Jessica Oldfield Dr Fatemah Rajah Dr Hazel Talbot Dr Cath Smith Dr Sam Wallis Dr Asrar Rashid Dr Abi Hoyle
Specialist trainees Dr Chris Vas Dr Umapathee Majuran Dr Usha Niranjan Dr Aparna Manou Dr Bob Basu Dr Mark Huddart Dr Ross Cronin Dr Kalwa Munthali Dr Suhail Habib Dr Shakir Mohammed Dr Abigail Callender Dr Louise Jordan Dr Lindsay Lewis Dr Tamanna Williams Dr Ameen Shamsudeen Dr Davinder Singh Dr Elizabeth Wilbraham
Lead nurse Suzanne Palmer
Clinical nurse educators Claire Howard Jo Whiston Ian Braithwaite Jenny Ashley
Advanced nurse practitioners Karen Spinks Sheila Hands Jan Hervo Rose Kent Ann Kelly Nia Evans Helen Doyle Sally Courtney
Senior transport nurses Jo Sharpe Tracey Carolan Louise Crabtree Alison Wolfenden Ann Jackson Karen Perring
43 Transport nurses Alison Clay Emma Richardson Michelle Pearsall Jennifer Dive Jamie Steele Karen Fletcher Charmaine Hamer Natalie Webb Claire Mclean Paul Rokhar Francois Brearley Louise Kay Catherine McNeilly Rebecca Russell-Ward
Call centre manager Ray Trent
Call handlers Audrey Pike Rebecca Dove Amanda Ford Stacey Harwood Sheila Holland Deborah Newbould Louise Roper Jennifer Butler Amy Stephenson
Administrative support Julie Smith
YAS drivers Steve Howarth Steve Holmes Sally Mitchell Steve O’Marr Paul Summerscales Paul Vickers Lisa Walledge Sally Levitt Dan Douglas Pete Fox Lee Boyes Julie Coddington Fiona Thornton Richard Eaton
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