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Interhospital transfer of sick children: proposal for a unified approach
  1. RAJNEESH WALIA, Consultant, Department of Neonatology
  1. The Royal Sussex County Hospital
  2. Brighton BN2 5BE, UK
  3. email: rajwalia{at}hotmail.com
  4. Leicester Royal Infirmary, Leicester, UK
    1. WREN HOSKYNS, Consultant, Department of Paediatrics
    1. The Royal Sussex County Hospital
    2. Brighton BN2 5BE, UK
    3. email: rajwalia{at}hotmail.com
    4. Leicester Royal Infirmary, Leicester, UK

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      Editor,—We read with interest the personal practice described by Rashid et aldiscussing their model of the regionalised transport service in New South Wales, Australia.1 They rightly stated that the success in the centralisation of resources and expertise in the care of critically ill children is dependent on a reliable and effective transport service.

      Systems that work well in other countries may not be appropriate for the UK, but there are lessons to be learned from North America and Australia. The need for adequate and appropriate intensive care services for children in UK has been discussed recently.2Implicit in centralisation of intensive care service is the provision of a coherent transport structure,3 which is crucial for the provision of a high quality service across the whole country.

      The size of the country and the population distribution in Australia and North America have forced considerations of transport on health care planners that has never been a high priority in the UK. The features of the New South Wales retrieval service that ought to be incorporated into the UK include: regional centralisation, integration of neonatal and paediatric retrievals, a central point of reference, telephone triage, and access to specialist advice.

      The model for the transport team is a doctor (usually an experienced training grade doctor) and trained transport nurse, but there is experience of nurse led4 or nurse–nurse teams (for example, Hospital for Sick Children, Toronto, Canada) supported by central coordination staff (usually a clinical fellow).

      Separation of the service from the hospital system in terms of funding and staffing also has advantages. It facilitates care of the sick child by establishing a standardised, safe, and reliable service, backed up by audit and research with potential to provide systematic training.

      The present paediatric transport system in the UK is ad hoc, fragmented, and centre dependent (neonatal or paediatric) with no plans for its integrated development. It is left to the individual intensive care units to arrange transport by diverting funds and staff from other clinical areas, resulting in a patchy, often intermittent service with wide regional differences and inadequacies. Neonatal and paediatric transport is sometimes integrated but more often separate, and the administrative task of identifying available beds and coordinating the response is largely borne by busy on call nursing and medical staff.

      The message from the Australian and Canadian experience is that a specialised transport system for children can work. Transport services need to cover a large population to be economic in terms of resources and manpower. This means cooperation between acute trusts on a regional basis, and amalgamation of neonatal and paediatric transport teams, with central telephone triaging and a central record of available neonatal and paediatric beds. This would provide opportunities for a seamless service by streamlining the administrative process (reducing response time and coordinating specialist advice), standardising equipment, and enhancing staff training and research. We hope that the issues will be resolved at a national level rather than left to the individual units to sort out local transport services for critically ill children.

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