Joint Maternity & Neonatal Guidance and Patient Leaflet
The London Neonatal Transfer Service (NTS) is the dedicated regional neonatal transfer service for London. They aim to be the single port of call for cot location and transfer of neonates between neonatal units across the London region, providing a consultant-led service based round the clock 365 days a year. They take pride in being safe, caring and efficient, delivering high standards of care in the field of neonatal transport medicine. The team works closely with the neonatal transfer services for Kent, Sussex, Surrey and the East of England as well as with the Children’s Acute Transfer Service (CATS) and the South Thames Retrieval Service (STRS) who together provide paediatric intensive care retrievals for London and the South East.
View the CATS information booklet.
View the How to Prepare for NTS Transfer doc.
Please see the following Letter on Elective Transfers in order to maximize the reach of the service.
London NTS is based at The Royal London Hospital, but is a service for all neonatal units in London. They have an emergency team that operates day and night, seven days a week, and an elective team who work during the day, Monday to Friday.
London NTS has three dedicated neonatal ambulances that are specially equipped to provide a mobile neonatal intensive care environment for babies needing transfer. The doctors, nurses, and paramedics who work on London NTS are all senior and very experienced in looking after very sick babies both in neonatal units, and in the transfer setting. Most babies needing an emergency transfer will be looked after by a doctor, nurse, and paramedic, whilst babies being transferred back to their ‘home’ hospitals will usually be accompanied by an NTS nurse and paramedic.
London NTS is the second busiest neonatal transfer service in the United Kingdom. However, according to the most recent national benchmarking exercise (undertaken in November 2014) they transfer the highest proportion of babies needing the most intensive support.
Between April 2014 and March 2015, London NTS received 2085 referrals (1345 emergency and 740 elective). Of these, 1186 babies were transferred by the emergency service and 406 by the elective service.
Pan-London Repatriation Guidance
NEW GUIDELINE – Jan 2022
This guideline has been compiled by a Task and Finish Group on behalf on the London Neonatal ODN. The group has extensive multidisciplinary representation from all levels of neonatal unit across London, plus parent and Neonatal Transport Service representatives.
Running a clinical neonatal network relies on repatriation of babies. This is the first repatriation guideline for the London Neonatal ODN.
The key aim is to improve EFFICIENCY and improve SAFETY in the repatriation process.
We are encouraging clear, timely, well documented communication between senior members of staff. We fully acknowledge that all neonatal units will have their own pre-existing systems for discussing/accepting/referring repatriation transfers. We are encouraging all neonatal units to review their practises, utilise the communication proforma in the guideline, and see if going forward we can consistently make repatriation as safe and efficient as possible, whilst simultaneously endeavouring to minimise stress for the families affected.
Please distribute the guidelines throughout your medical and nursing teams, encouraging them to read it through thoroughly, and embed it into practise.
Pan-London Repatriation Guidance – SAFEty NeT tool
To support safe transfer of babies within the network please ustilise the following network transfer document created for local units. Contact your local transport service to discuss transfers where possible.
NTS Cooling Toolkit: Case note review to establish a standardised approach to the assessment of encephalopathy, which will be used for all patients whom NTS transfer for therapeutic cooling
TRIPS adaptation for NTS: Transport Risk Index of Physiologic Stability, a means of establishing an illness severity score which will be applied at referral as a means of triage
Tecotherm for warming and maintaining normothermia: A quality improvement project with the aim of achieving and maintaining normothermia in extremely premature infants, with the use of the Tecotherm.
Post PDA ligation transfer: Quality improvement project to aid efficient and comfortable patient transfer following duct ligation. Implementation of a standardised pain score. Plans to measure efficacy of intervention in six to twelve months’ time.
Development of London NTS Palliative Care Referral and Transfer pathway: A pan-London survey was conducted (Jan 2017) and a referral guide and pathway have been written. Team introduction and unit dissemination to follow.
NTS journey times: A project to ascertain the travel time between each of the London units, to aid decision making and resource allocation
NTS technology and innovation:
- RADAR (Referral management, Analysis of risk, Decision support, Audit, clinical Record keeping) a tool designed to give real-time data of team activity, shift personnel data and live updates such as equipment bulletins
- NTS website – an area where service users can find information relating to the service and aid preparation for referral and transfer of patients from their unit as well as upcoming educational opportunities such as NEST
NTS Risk Newsletter: Establishing a regular risk newsletter with the aim of shared learning from reported events. You can find our latest summary and a list of our upcoming training events here.
NTS Team Handover: Quality improvement project to assess the NTS handover of patients transferred
Parent feedback: Quality improvement project with aim of increasing amount of feedback gained following patient transfers
In addition to both the clinical and operational projects, we welcome and support Undergraduate Medical Student Selected Component (SSC) projects. These are supported by both NTS Consultants and the medical and nursing teams
CoolTriP Pathway and Decision-making Tool
The tool aims to standardise the approach to cooling decisions across the network, encouraging senior clinician involvement, to improve the recorded documentation of such decisions and enhance safe practice through an aide memoire.
The London NTS is available for all emergency transfers (as described above) from London neonatal units to other London neonatal units, (this includes surgical and cardiac units), as defined by the boundaries of the M25.
If a baby needs an emergency transfer to a neonatal unit outside of London due to an acute lack of capacity in London, then it is within the remit of the London NTS to undertake the transfer. This does not apply to planned repatriations to the baby’s ‘home’ unit.
If however a baby is being transferred to a London neonatal unit from a unit outside of London, then the transfer should be undertaken by the transfer service which covers the area that the referring unit is located in.
Repatriation transfers fall to the transfer service covering the home postcode of the parents if a baby is being repatriated to outside London.