Reducing Term admissions to Neonatal Units

The NHS has made it a priority to reduce the admission of full term babies (those at 37 weeks gestation and over) to neonatal units.

With the true desired outcome being a reduction in moderate and severe harm to term babies, admission to neonatal care is assumed to act as an indicator that harm has taken place somewhere in the maternity or neonatal pathway.

Reducing premature mortality and caring for people in a safe environment and protecting them from avoidable harm are specific indicators in the NHS Outcomes Framework.

As well as reducing harm, this work programme aims to reduce separation of mother and baby. When maternity and neonatal teams work together, outcomes for babies, mothers and families are optimised and separation avoided.

In 2013 almost 60% of all neonatal admissions to English neonatal units were at term, highlighting a year on year increase in term admissions from 56.6% in 2011 to 58.3% in 2013. In order to capture a comprehensive understanding of the issues, five sources of intelligence were used:

  1. Neonatal data as derived from the National Neonatal Research Database, maintained by the Neonatal Data Analysis Unit.
  2. Safety data as informed through reports to the National Reporting and Learning System (NRLS)
  3. Parent and patient experience
  4. Claims data as informed by the NHS LA Claims Management System
  5. Front line clinical staff dealing with term admissions on a daily basis.

Work on reducing term admissions is focusing on five key areas:

For each of the five areas a working group has been set up to scope the work and develop the priorities and deliverables. Click on the relevant links to see more about this work and those involved.

Correspondence to date

The correspondence and communication documents here may provide a background to the Term Admissions work and include a number of key updates that have been issued across the relevant communities involved.

Letters to English units:

Letters to Welsh units:

Meeting notes:

Presentations from initial stakeholder meeting held on 03.11.14:

Alignment with and other related work programmes

This table has been produced to demonstrate how the work to reduce term admissions to neonatal units aligns with other national work streams. It will be updated on an ongoing basis (last updated June 2015). Participation by units in one or more of the work programmes outlined in table 1 will therefore bring about improvements in one or more area but reduce duplication of effort and additional burden by doing so.

Maternity and Newborn, Children and Young People’s Patient Safety newsletters

Shared resources to support identification and management of at risk infants

The work of all focus groups has benefitted from a number of maternity and neonatal units and organisations sharing their improvement work, audits and developments. Many are listed throughout these web pages to provide support and encouragement in order for others to examine and consider changes for improvements. Inclusion of a particular resource does not necessarily endorse it for the issues in your organisation; all patient safety improvement measures require an examination of the resource, the system and the risks before planning implementation and review.

Early Warning Tools for identification and support of the Newborn

BAPM – NEWTT: The British Association of Perinatal Medicine have worked collaboratively to develop an evidence based National Neonatal Early Warning Trigger and Track tool.  The tool is for use within newborn and maternity services across the United Kingdom. It is designed to be used by healthcare professionals working in areas caring for newborns in the early and ongoing postnatal period. Whilst we expect this to be predominantly midwives, it may also include maternity care assistants, nursery nurses and, in some instances, neonatal nurses.  The areas where it may be best utilised are delivery suites and postnatal ward areas. In certain circumstances, it may be deemed appropriate for other settings such as special care units (SCU), transitional care units (TCU) and perhaps community settings.

The NEWTT framework seeks to:

  • Identify those babies at risk of clinical deterioration following birth
  • Provide a standardised observation for monitoring clinical progress
  • Provide a visual prompt to aid identification of abnormal parameters by colour coding e.g. red, amber
  • Reduce admission to neonatal units
  • Reduce/limit separation of mother and baby by early identification of and intervention for at risk infants
  • Through early identification and intervention reduce the severity of illness for some infants who will require admission to neonatal units

It is important to note that the NEWTT framework should be used as an adjunct to aid clinical assessment of infants and is not intended to replace competent clinical judgement.  Additionally, it should be used alongside local clinical guidelines, recognising that acceptable parameters for normal values will vary between institutions.