PIPER - Paediatric Infant Perinatal Emergency Retrieval

Arranging a bed

  • Overview/procedure description

    To communicate and organise with appropriate hospital personnel, a bed for a pregnant woman in need of emergency transfer from another hospital.

    Related Policy

    Nil

    Definition of Terms

    PIPER     Paediatric Infant Perinatal Emergency Retrieval

    ARV       Adult Retrieval Victoria

    RWH      The Royal Women’s Hospital

    MMC      Monash Health

    MHW      Mercy Hospital for Women

    NICU      Neonatal Intensive Care Unit

    ICU        Intensive Care Unit

    Procedure details

    Process

    The majority of in utero transfers are made to one of the three tertiary maternity services, Mercy Hospital for Women (MHW), Monash Medical Centre (MMC) or Royal Women’s Hospital (RWH). However, some women presenting to smaller units, especially with problems occurring between 32-36 weeks gestation, can access services appropriate to their needs in one of the larger rural or metropolitan hospitals.

    If the principal purpose of transfer is to access adult ICU facilities for an acutely-ill mother, commonly but not always post-partum, then the consultant on-call for Adult Retrieval Victoria (ARV) should become the lead clinician managing the case, supported by the PIPER Perinatal consultant, and will take responsibility for accessing an ICU bed, and if required, despatching an ARV medical retrieval team.

    The PIPER Perinatal consultant should first determine whether transfer of the patient is necessary in order to access optimal facilities for care. If so, the consultant should indicate to the co-ordinator the urgency of transfer. In cases where the mother is in active labour, consideration should also be given to the feasibility and safety of transfer, in order to minimise the risk of delivery occurring while in transit. In some cases, it will be safer for the delivery to proceed at the peripheral hospital, with subsequent PIPER Neonatal retrieval of the newborn.

    In a small number of cases the transfer is, or becomes, ‘time critical’, defined as there being only a brief window of opportunity to initiate and achieve safe transfer.  In these cases the referring hospital will be asked to initiate transfer immediately, and a provisional destination hospital will be nominated. If more than one tertiary centre has NICU bed availability, the patient will be directed towards the geographically closest of the tertiary centres. If only one tertiary centre has NICU bed availability the patient will be directed towards that centre. If there is no NICU availability, the patient will be provisionally directed towards the geographically closest tertiary centre and a conference call will be set up between representatives of the tertiary NICU & maternity services, initiated jointly with the PIPER Neonatal consultant, to ascertain the disposition of the patient.

    Contact points for bed finding

    • MHW – Maternity nursing supervisor (03) 8458 4126 or page via switchboard (03) 8458 4444.
    • MMC – Obstetric registrar on for Delivery Suite, (03) 9594 6666, pager 258.
    • RWH – Mon-Fri 0700-1500 call Bed Manager; out of hours call After Hours Manager; page via switchboard (03) 8345 2000.
    • Base and larger metropolitan hospitals – various local arrangements apply.

    In the event that neonatal capacity is the issue preventing appropriate maternal transfer, the PIPER Perinatal consultant should seek the assistance of the PIPER Neonatal consultant, who will put in place the appropriate escalation processes, up to and including discussing the possibility of interstate transfer with representatives of the Department of Health.

    Escalation processes in cases where maternity capacity is the critical issue blocking access

    Where the transfer has been deemed ‘time critical’, and after 15 minutes the admission has not been accepted by the bed co-ordinator or registrar at the hospital to which the patient has been provisionally directed, the PIPER Perinatal consultant will be able to exercise the option of over-riding  the bed co-ordinator or registrar. The PIPER Perinatal consultant should then follow up with a personal call to the Clinical Service Director or their delegate at the destination site, to discuss the case.

    In other cases, if a bed cannot be secured due to maternity capacity issues, the PIPER Perinatal consultant should escalate discussions to one or more of-

    • MHW – Director of Obstetrics (or delegate), page via switchboard (03) 84584444
    • MMC – Obstetrician on-call & Women’s & Children’s Nursing Director, page via switchboard (03) 9594 6666
    • RWH – Director of Obstetrics (or delegate), page via switchboard (03) 93442000.

    If this process is still unsuccessful, the second-level contacts should be asked to advise their CEO (or executive on call).

    If there are cases for whom beds are still being sought at the beginning of each 24hr PIPER Perinatal consultant on-call period, the co-ordinator should provide an update to the incoming PIPER Perinatal consultant, who may opt to conference again with the referrer to ascertain the clinical urgency of transfer.

    For referrals received before 4pm on the preceding day, where urgent transfer is required and a bed has not been secured by 10am the following morning, the PIPER Perinatal consultant will contact the nominated contact within the Department of Health to discuss the capacity constraints.

    For referrals received before 10pm on the preceding day, where urgent transfer is required and a bed has not been secured by 4pm the following afternoon, the PIPER Perinatal consultant will contact the nominated contact within the Department of Health to discuss the capacity constraints.

    Department of Health actions may include:

    • Await scheduled PIPER Neonatal teleconference (if one activated)
    • Contact tertiary executives (or executive on-call) to discuss capacity constraints and options
    • Request tertiary service access managers to attend teleconference
    • Contact executives at other services if back transfers identified to be an issue
    • Request a teleconference including access managers and executive.

    Reference

     

    Contacts