In an effort to standardize referral and transport procedures from outlying hospitals to the Vanderbilt Children’s Hospital, referring pediatricians requests for neonatology consultation and Angel transport are now being handled through the LifeFlight Communications office.

Notification has been sent to all outlying nurseries in Vanderbilt’s referral region directing community physicians to call 615-322-2275 with their request for consultation/transport.

If a referring physician does call the VUMC NICU directly, the medical receptionist should transfer the phone call to the LifeFlight Communications number (x2-2275).  (If the fellow or attending on call is immediately available, the MR may hand the phone to the neonatologist on duty to immediately assist the outside physician.) When transferring the call to LF dispatch, the medical receptionist should either stay on the line and direct the LifeFlight personnel that the call is regarding a newborn transport, or advise the calling physician to explicitly ask about newborn transport.

The Life Flight dispatcher should answer the x2-2275 line “Vanderbilt Newborn Transport” and request the following information from the referring physician:

            -Name of the requesting hospital and referring MD

            -Call back phone number

            -The infant’s name, sex, gestational age, birth date and time, and clinical problem

The LF dispatcher will then inform the referring physician to expect a prompt return call from the VUMC Neonatology staff.

[If the initial information clearly suggests that a transport is needed, the transport team (NNP, NICU transport nurse, driver, charge nurse, Lead RRT, and LifeFlight team, if applicable) will be alerted with a STANDBY satellite page while further exchange of information occurs.]

The admitting NICU fellow or attending will then be notified by satellite pager to call the communications center at x2-3211.  The dispatcher will relay the above information to the NICU physician.  The NICU fellow may then request a transient delay in the call back in order to prepare for the consult or pre-transport stabilization recommendations.  Once the admitting fellow is ready, the dispatcher will set up a 3-way recorded call to the referring MD.  Recorded calls are now an EMS standard for documentation and liability purposes.

(If the neonatology fellow or attending receives a call for consultation or transport directly from a community physician, (s)he should gather the necessary transport information (see above) as well as clinical details of the infant’s course, and assure the outside doctor that transport will be arranged.  The NICU physician should then call the LifeFlight Communications center after accepting the transfer and give them the necessary details and transport plan to activate the paging system.  If the direct call received was for consultation only, no call to LifeFlight is necessary, and the NICU physician should simply complete the standard Neonatology Consultation documentation form.)

The admitting fellow or attending should gather all necessary clinical information from the referring physician and offer recommendations for the infant’s ongoing stabilization, work-up, and care as appropriate.  The NICU physician is also responsible for deciding whether transport is needed, and the most appropriate mode of transport (Angel ground, LifeFlight helicopter, Med Center air fixed wing, etc.)  The NICU physician should inform the referring physician about what to expect from the transport (ETA, etc.) as usual.

Once the fellow confirms transport with LifeFlight dispatch, the transport team and essential NICU personnel will be notified by satellite page RESPOND with directions regarding mode of transport.  The transport team should call LifeFlight back to confirm that they received the page to assemble and then meet in the designated area (Emergency Department or helipad) within 15- 30 minutes.

[A CANCELLED page will be sent if the call was for consultation, with no transport to follow.]

After talking with the referring MD, the NICU fellow or attending should contact the transport NNP to further discuss the infant’ problem, care, and admission plan.

The following items should accompany the transported infant:

• Photocopy of mother’s prenatal history

• Photocopy of mother’s and baby’s medical records, including nurses’ notes

• Completed VCH Infant Referral History Form

• Duplicates of all baby’s x-rays

• Discharge summary for babies with prolonged hospitalizations

The Vanderbilt Hospital Admitting Department will call to obtain information about the family’s residence and insurance coverage.  This should not preclude or delay the dispatch of the Angel transport team.

Discussed at the Regionalization meeting 3/19/03 and reviewed at Collaborative Pathways committee meeting 3/26/03.