Back-Transport guidelines

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.  For parents from significant distances, 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.

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

Identify infant(s)

Identify the infant(s) ready to be back transported based on their stability and the parents or referring MD’s request.  Plans for BT should be discussed on rounds for the whole healthcare team’s input.  Infants deemed ready to BT within the week should be referred to Katy Prince or the infant’s case manager.

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 Manual” at the TeamWork Station.  Katy Prince and the case managers can help identify this information.

Obtain parental consent

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

Obtain receiving physician 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.

Discuss Nursing Needs of Patient with Receiving Nursery

Communicate with the receiving nursery (phone numbers are located in the “BT Manual”) the plan or 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.

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 ultrasound, hearing screens, hematocrit, ROP exams, etc.)  Obtain copies of any films (CXR, HUS, etc.) that need to be sent with the infant.  Ask the case managers to schedule any follow-up appointments (NICU follow-up clinic, ophthalmology, etc.) that need to be made prior to transport.  Ask the medical receptionist to pull the newborn screen (PKU) form and order it with labwork.

Prepare discharge summary

The discharge summary needs to be ready to transport the infant.  It should be in Star Panel in advance and updated the morning of BT before rounds.  The intern/resident in charge should print off at least 2 copies.  One of the copies is for the chart and one is to go with the transport team for the receiving nursery/physician. If desired, an additional copy may be given to the parents.

On the day of BT

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

Special considerations

For the Back Transport Program to continue to be a resounding success, infants for BT must be carefully chosen.  Infants should not be back transported if there are any concerns about the infants continued stability or if the parents or the accepting physician have unresolved reservations.

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

Ventilated infants being back-transported to other Level III NICU’s must be transported via an Angel team.

Some community nurseries have the capability to pick up potential back transport patients.  This service may be invaluable when the NICU is over-census and the Cherub back transport team is working at maximum capacity.  A list of nurseries which can perform their own transports is available in the “BT Book”.

To arrange transport of FT. Campbell babies, please notify Katy or the NICU case manager to obtain preauthorization for these babies to BT to Clarksville if Ft. Campbell cannot accept the baby.