Back-Transport guidelines

(Version 1.0 2/18/2002 - 6/26/2007)

The main objective of the Back Transport Program is to provide a safe transition of care of a stable infant who no longer requires intensive care to a nursery closer to his/her home. Parents from significant distances should be informed that back-transport is an option if they so desire once their baby no longer requires intensive care.

In addition to helping parents who must travel great distances to visit their infant at Vanderbilt, the back-transport of preterm infants to community hospitals helps maintain community pediatricians’ neonatal skills and helps to familiarize each infant’s local physician with his/her care prior to discharge home. And, by preventing overcrowding in the VUMC NICU, the Back Transport Program helps to maintain bed space for critically ill neonates who require treatment at a Level III center for survival.

Infants should not be back transported if there are any concerns about the infant’s continued stability or if the parents or the accepting physician have unresolved reservations.

Do not back transport infants who weigh < 1500g or are < 32 weeks PCA to anywhere other than a Level III NICU or a Level II unit staffed with neonatologists (Baptist, Centennial, Gateway, etc).

When an infant is approaching goals necessary for back-transport, the following guidelines will help facilitate the process. Katy Prince, R.N.C. (beeper #835-9475) coordinates back transports and can help with any questions.

    1. Identify infant(s)

      Identify infants ready to be back-transported based on their stability. Plans for BT should be discussed on rounds for the whole healthcare team’s input. Infants deemed ready to BT within the week should have their name and destination written on the "Discharge Plans" board at the NICU desk.

       

    2. Determine receiving nursery

      Determine the nursery to which the infant is to be transported based on the parents’ residence and the accepting pediatrician’s hospital affiliation. The receiving nursery’s capabilities will help determine timing of the infant’s back transport. Descriptions of equipment and capabilities of community nurseries are located in the "BT Book" at the NICU desk. Case managers can help identify this information.

       

    3. Obtain parental consent

      Obtain the parents’ consent to back transport their infant. Back Transport Consent Forms are located at the NICU desk. Specify in writing the BT hospital. Witness their signature if it is a signed consent; have an additional witness sign if it is a phone consent. Any licensed personnel may obtain this consent

       

    4. Obtain the receiving physician’s acceptance

      Call the receiving physician to accept transfer of care of the infant. If the infant is being transported to a hospital under the care of a physician other than his/her future pediatrician, the future pediatrician should be notified also.

       

    5. Discuss nursing needs of the patient with the receiving nursery

      Communicate with the receiving nursery (phone numbers are located in the "BT Book") the plan of care for the baby. The BT nurse or case managers will be glad to do this if available, but communication should be done a day in advance to increase their preparedness to accept the infant’s care.

       

    6. Schedule screening tests and follow-up at least one day prior to BT

      Order any screening tests at least one day prior to transport (head ultrasounds, hearing screens, hematocrit, ROP exams, etc.) Obtain copies of any films (CXR, HUS, etc.) that need to be sent with the infant. Also order any follow-up appointments (NICU Follow-Up Clinic, ophthalmology, etc.) to be made prior to transport. Ask the medical receptionist to pull the newborn screen (PKU) form for lab collection. A"BT Information Checklist" is kept in the BT Book to double check what arrangements have been made or still need to be completed.

       

    7. Prepare discharge summary

The discharge summary needs to be available to transport the infant. It may be typed on WIZ in advance and updated the morning of BT before rounds. The intern/resident in charge should print off at least 3 copies, proofread and sign them. One of the copies is for the attending’s office, one is for the receiving nursery, and one is for the chart.

  1. On the day of BT

The attending physician should see the infant before rounds prior to transport. The housestaff must write BT orders. The nurse should ensure that appropriate medications, breastmilk/or special formula, and other belongings are packed with the infant. The BT team will notify the family and the receiving nursery of an ETA.

Special considerations:

  1. Ventilated infants being back-transported to other Level III NICUs must be transported via Angel or Med Center Air rather than Cherub.
  2. To arrange transport of Ft. Campbell babies, please notify the NICU Case Manager to obtain preauthorization for these babies to BT to Clarksville if Ft. Campbell cannot accept the baby.
  3. Some community nurseries have the capability to pick up potential back transport patients. A list of nurseries which can perform their own transports is available in the "BT Book.

Most recently discussed at the Clinical Division Meeting 02/18/02

       Archived Versions:  None