CHANTS is a dedicated service that operates within South Wales. The team is committed to providing safe transfer of neonates requiring intensive care and specialist ongoing care according to clinical requirements.
The clinical service is provided by neonatal staff in Cardiff, Newport and Swansea working one week in three in rotation. The dedicated ambulance service is provided by the Welsh Ambulance Service Trust (WAST).
CHANTS operates a 24 hour service, 365 days of the year, but it should be noted that service provision differs slightly between day and night:
While capacity transfers would not routinely be undertaken between 8pm and 8am, it may be a necessary to transfer a baby to create critical care capacity, only if there is no available space across the three NICUs. Capacity transfer requests internal to a unit will not be addressed by the night team.
When a local unit is not able to provide an appropriate level of care, the baby will require an ‘uplift’ transfer. This may be for medical intensive care, surgical, cardiac or any other specialized service.
Once the baby is more stable, ‘repatriation’ can be initiated, so that their ongoing care is delivered as close to home as possible. These repatriations to the local unit where possible should be planned at least 24 hours in advance. As they are planned, it is expected that they should be completed within the day shift (8am to 8 pm).
An uplift transfer has been defined by the Neonatal Transport Group as “a transfer for care that the referring centre does not normally offer.” This may include the following examples:
The service will not provide resuscitation at birth. Also, the service will not usually provide transport for Extra Corporeal Membrane Oxygenation (ECMO), as this specialised transport is provided by ECMO centres as an integrated part of their service.
The referring unit consultant should contact the transport consultant at the earliest opportunity with full details of the proposed transfer.
The CHANTS doctor led referral documentation should be completed, with a printed version available for the notes and the CHANTS team on arrival.
When the details have been obtained, the transport team will be responsible for locating a suitable neonatal cot.
A discussion with the parents is necessary to explain the reason for the transfer. At this point a CHANTS parent leaflet should be handed to them.
The referring unit should liaise with the receiving unit requesting the repatriation or need for transfer due to capacity.
This requires a medical discussion and handover where all the relevant clinical information should be provided. The suitability of the transfer should be ascertained with regards to the clinical condition of the baby. The baby should be stable and meet the criteria for the receiving unit.
A discussion with the parents is necessary to explain the reason for the transfer, prior to referring to the CHANTS team. At this point a CHANTS parent leaflet (hyperlink) should be handed to them.
Once the transfer has been accepted by the receiving unit, a request should be made to the CHANTS team on duty (hyperlink) by telephone.
The duty neonatal transport consultant should be contacted by the referring hospital with full details of the proposed transfer:
It is helpful to mention the type of milk the baby is on especially donor breast milk (DBM) and if the receiving unit need the DBM to be transferred. It is recommended that these transfers are provisionally booked with CHANTS in advance. This enables CHANTS to organize multiple transfers from different units efficiently.
If on the day, however, an uplift transfer/ capacity referral is made, it is likely a repatriation request will be postponed or rescheduled. Repatriations are usually prioritised the lowest category when there are multiple transfer requests. If the baby is almost fully fed and very nearly able to be discharged home, the prioritisation will be reduced further, as the benefit to the neonatal network in terms of efficiencies is small and not cost effective.
During the telephone referral call, provide the CHANTS team with an email address, so the team can send the appropriate referral form for completion. The completed form can be emailed back to the CHANTS team, and/or a copy printed for the team when they arrive at the cot side.