Policy for Emergency Neonatal Referrals.
Procedure The management of newborns too unwell for the hospital of birth can be discussed with duty paediatric staff at the regional Base Hospital (mildly unwell patients) or the neonatal staff of a Tertiary Referral Centre (sick or very preterm infants).
They will offer assistance, including acceptance of the patient for transfer. They will also arrange an alternative suitable destination where appropriate. The referring doctor should not have to 'ring around'.
NETS can be contacted by any of these parties and can link callers by 'conference call' when this is helpful. For instance, a GP in a rural hospital may contact the regional paediatrician about a newborn problem. If the newborn is sick, the paediatrician might ask NETS to assist with advice and/or will send a team to the patient. At that time, the appropriate destination for the baby (regional hospital or city Perinatal Referral Centre) can be discussed and the NETS team will then transport the baby to whichever hospital is decided as appropriate. Another dilemma is whether the patient has a 'medical' or a surgical or cardiac problem. This will determine whether a perinatal hospital or a children's hospital is the most appropriate destination. NETS can make these arrangements (or make alternative ones) as required.
The roles of the Tertiary Referral Centres can be summarised as follows:

HOSPITAL Medical Care Surgery Cardiac Service Phone

John Hunter Children's Yes Yes No 02 4921 4365

Nepean Yes No No 02 4724 2850

Children's at Westmead Yes (see note 1) Yes Yes 02 9845 1177

Royal Hospital for Women Yes No, (but see note 2) 02 9382 6160

Royal North Shore Yes
No
No 02 9926 7224

Royal Prince Alfred
Yes

No

No
02 9515 8459

Sydney Children's Yes (see note 1) Yes Yes 02 9382 1918

The Canberra Yes Yes No 02 6244 4075

Westmead Yes No, (but see note 2) 02 9845 7375

Arranging transfer Each Perinatal Referral Centre and Children's Hospital has a neonatal ICU registrar (with backup from a consultant neonatologist). If another specialist (surgeon, cardiologist, etc.) is contacted and the patient needs intensive care, they will liaise with the Unit about the patient. Advice about patient management and for patient transfer using a referring hospital escort can be arranged directly with the preferred hospital. However, for sicker or unstable patients, a medical retrieval should be arranged through NETS. The call to NETS can involve any of the destination hospital staff using the NETS' conferencing facility.
NETS seeks a destination hospital according to the referring doctor's preference. A computerised bedstate 'noticeboard' displays bed availability for all Units in New South Wales and the Australian Capital Territory. Whenever a specific preference is expressed that hospital is contacted (even if the bedstate indicates "full"). Bed availability changes frequently and sometimes a bed becomes available or the consultant neonatologist feels the particular clinical problem warrants taking action to make a bed available. If a bed is not available for the patient, another hospital with appropriate facilities for the particular clinical problem is selected. The referring doctor can specify their second (and third) preferences
Ideally, referring staff should expect to make only one phone call.
Tertiary hospitals may contact NETS if they are unable to obtain a bed in either their own hospital or a suitable alternative hospital for a patient referred to them. Tertiary hospitals seeking to move a patient to another tertiary hospital for logistic rather than clinical reasons will be most successful if they arrange the bed directly. This may require consultant-consultant communication.
Escorts The type of clinical escort required for the patient should then be determined. A medical retrieval team from NETS can be made available by any vehicle (road, helicopter or fixed wing). For less sick patients who are stable, an escort from the referring hospital may be appropriate. Call the NETS Line for retrievals and the Ambulance Service for transfers. Flight nurses employed by the NSW Ambulance Service provide a high level of skill for patients moved by fixed wing air ambulance. Click for a summary of telephone numbers.
Vehicles. The choice of vehicle for a medical retrieval will be made according to published guidelines which take clinical urgency, distance, patient condition, team and vehicle availability, access to referring and receiving hospitals and other factors into account.
Note 1:A perinatal hospital may be the preferred destination if both mother and baby require care at the destination hospital.
Note 2: This Perinatal Centre is directly linked to a Surgical Unit and is the preferred and desirable place of birth for a baby needing major neonatal surgery.

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