A national retrospective review of neonatal critical care transfers in dedicated critical care transport services in the private sector

Venter, Mareli; Theron, Elzarie; Williams, W. T.; Khan, W; Stassen, Willem

doi:10.7196/samj.2021.v111i10.15736

Cited by 2 publications

(7 citation statements)

References 15 publications

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“…Perceptions of the expert group on the presented case mix from Venter et al [ 17 ] is described first. Experts agreed with the representation in the case mix when compared to their own experiences.…”

Section: Resultsmentioning

confidence: 99%

“… Topic examples provided by participants: 1) Neonatal anatomy and physiology 2) Critical Care retrieval systems 3) Specific conditions suggested are: Conditions from the study [ 17 ]; congenital heart defects; infection; prematurity; respiratory conditions (bronchopneumonia, diaphragmatic hernia, meconium aspiration, persistent pulmonary hypertension); surgical emergencies (gastroschisis, necrotising enterocolitis) 4) Examples include feeding and skin care 5) Specific to referral documents, information gathering, and handover 6) Examples include: airway management, neonatal resuscitation, thoracentesis 7) Examples include: incubators, infusion devices, mechanical ventilators (see no. 13) 8) Examples include: Colostomy bags, drains, vascular access (arterial access, central intravenous access, intraosseous access, peripheral intravenous access, umbilical vascular access) 9) No specific examples given 10) Assessment of the neonate, and specifically for the conditions in 3.…”

Section: Resultsmentioning

confidence: 99%

“…The discussion schedule was informed by literature [ 17 , 20 , 28 – 32 ], and developed by the authors collaboratively through constant discussion and revision. This schedule was used as a guide by the facilitators during the interviews.…”

Section: Methodsmentioning

confidence: 99%

“…Participants were provided with a pre-reading document that informed the interviews and focus group discussion. The expert group’s pre-reading document described the neonatal population currently transferred in South Africa, as described by Venter [ 17 ]. The diagnoses, attachments and medications involved during the CCR of these neonates by dedicated teams were represented in charts and tables.…”

Section: Methodsmentioning

confidence: 99%

“…Internationally, neonatal transfer and retrieval is most often undertaken by dedicated multidisciplinary teams with specialised equipment and additional training [ 12 , 16 ]. This is not the case in South Africa where these transfers are mostly undertaken by prehospital emergency care providers with no more than their baseline training [ 17 ]. Previously, calls have been made to standardise training and core competency standards for all providers that undertake neonatal and Critical Care Retrieval (CCR) [ 18 ].…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Developing a South African curriculum for education in neonatal critical care retrieval: An initial exploration

Williams,

Theron,

Khan

et al. 2023

PLoS ONE

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Background Owing to limited or centralised neonatal critical care resources, the interfacility transfer of neonates is inevitable. In many high-income settings, dedicated Critical Care Retrieval Services (CCRS) with additional education and training undertake neonatal critical care retrieval (CCR). In South Africa, however, these transfers are mostly conducted by advanced paramedics with limited education in neonatal care, and this may lead to high adverse event rates. In SA, a shortage of skilled neonatal interfacility transport services has been identified as one of the top ten avoidable causes of under-5 mortality. In order to address this gap in neonatal transfer education for paramedics in South Africa, the aim of this study is to develop a curriculum for neonatal critical care retrieval in South Africa. Methods Using Kern’s approach to curriculum development, a general and targeted needs assessment was conducted through semi-structured interviews with experts in the field and a focus group discussion with a prospective student group. Interviews were preceded and informed by a literature review and retrospective chart review of neonates who underwent CCR in SA over a one-year period. Audio recordings of interviews were transcribed verbatim and subjected to inductive-dominant content analysis. Finally, qualitative codes were expanded into course outcome and a curriculum map was developed. Results Six experts in neonatal critical care and retrieval participated in semi-structured interviews with a mean duration of 59 minutes. Following transcription and analysis, 372 codes were developed. Seven prehospital providers (prospective students) who are involved in neonatal transfers in South Africa participated in a focus group discussion with a duration of 91 minutes. The audio recording was transcribed and analysed with 97 codes extracted. The main categories were: Current status of neonatal CCR in South Africa; learning and education in neonatal CCR; and proposed curriculum structure. The proposed curriculum structure described 13 broad course outcomes to be delivered as a blended postgraduate programme. Participants noted that funding, employer buy-in and internet resources would be required. The targeted prospective student group should be all Advanced Life Support (ALS) providers with a change in their scope of practice on completion. Conclusion This study described the need for additional education in neonatal critical care retrieval due to the limitations in the current and past education systems. This study provides a curriculum structure with course outcomes that can be used as a basis for the development of a complete curriculum for education in neonatal CCR, with the potential to greatly reduce adverse event rates.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Developing a South African curriculum for education in neonatal critical care retrieval: An initial exploration

Williams,

Theron,

Khan

et al. 2023

PLoS ONE

Self Cite

View full text Add to dashboard Cite

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A national retrospective descriptive analysis of critical care transfers in the private sector in South Africa

Venter,

Stassen

2023

S Afr Med J

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Background. Critical care transfers (CCTs) are necessitated by the growing prevalence of high-acuity patients who require upgrade of care to multidisciplinary teams from less-equipped referring facilities. Owing to the high acuity of the critical care patient, specialised teams with advanced training and equipment are called upon to undertake these transfers. The inherent understanding of the potential effects, and therefore the needs of the critical care patient during transfer, are affected owing to the paucity of international, but more specifically, local data relating to CCTs. Objectives. To describe a cohort of patients who underwent CCT by dedicated critical care retrieval services (CCRS) in the private sector in South Africa (SA). Methods. This retrospective, descriptive study sampled all paediatric and adult CCTs completed over a 1-year period (1 January 2017 - 31 December 2017) from the dedicated CCRS of two national emergency medical services in SA. All neonatal patients were excluded. Data were extracted from patient report forms by trained data extractors and subjected to descriptive analysis. Results. A total of 1 839 patients were transferred between the two services. A total of 3 143 diagnoses were recorded, yielding an average of ~2 diagnoses per patient. The most prevalent primary diagnosis was cardiovascular disease (n=457, 25%), followed by infection (n=180, 10%) and head injury (n=133, 7%). Patients had an average of ~3 attachments, with the most prevalent being patient monitoring (n=2 856, 155%), peripheral intravenous access (n=794, 43%) and mechanical ventilation (n=445, 24%). A total of 2 152 instances of medication infusion or administration were required during transport, yielding an average of ~1 medication or infusion per patient transported. The most common medications recorded were central nervous system depressants (n=588, 32%), followed by analgesics (n=482, 26%) and inotropic or vasoactive agents (n=320, 17%). Conclusion. This study provides insight into the demographics, most prevalent diagnoses and interfacility transfer monitoring needs of patients being transported in SA by two private dedicated CCRS. The results of this study may be used to inform future specialised critical care transport courses and qualifications, equipment procurement and scopes of practice for providers undertaking critical care transfers.

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A national retrospective review of neonatal critical care transfers in dedicated critical care transport services in the private sector

Cited by 2 publications

References 15 publications

Developing a South African curriculum for education in neonatal critical care retrieval: An initial exploration

Developing a South African curriculum for education in neonatal critical care retrieval: An initial exploration

A national retrospective descriptive analysis of critical care transfers in the private sector in South Africa

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