The Newborn Emergency Stabilisation and Transport (NEST) team are based at St Michael’s Hospital in Bristol and so this is the base for the start of my shift.  My shift starts at 8am (or 8pm if I am on the night shift!) and begins with a handover from the team who are finishing. We follow a fixed briefing structure to ensure that no information is missed and discuss all aspects of the service including daily staffing, planned and expected jobs and even weather conditions. During this morning handover we also have a 10-15 minute teaching session where we will discuss different scenarios/conditions we may find in practice and develop action plans/learning points from these.

The equipment is then checked to ensure that it is all present, in full working order and clean, ready for any emergency phone calls we may receive. Most of this is usually done by the NEST nurse, but we all work together as a team to ensure we remain familiar with the equipment and up to date with any changes.

If we are not going out on an immediate job then we usually spend the next hour reviewing cases from the previous day. All NEST transfers and advice calls get reviewed by a full team including a Nurse, Advanced Neonatal Nurse Practitioner (ANNP) and Consultant, and following a structured review sheet all elements of the transport and documentation are examined. These are often really interesting and frequently result in learning for the entire team who are reviewing the cases, as well as being an important governance exercise.

Once the reviews are completed the NEST ANNP then phones all the local neonatal units in the Western half of the SW network (7 in total) to find out about their staffing, cot capacity and the dependency levels of their patients. It is also a good time to find out about any infants that may require the transport service over the next few days. This allows us to plan our non-urgent work and prioritise which babies to move first. We cover a large geographical area so it can be helpful to plan jobs that are closer in distance, or between the same two units.

If there are planned transfers the ANNP may be needed to support the nurse in transporting the baby between two units, for example if they need any support with their breathing or have certain lines in place. Before we leave base we take a comprehensive referral over the phone and check that everything is in place ready for the transfer and that parents are fully aware of the plan. We then go and meet the baby and family at the referral unit introducing ourselves to everyone before finding out all about the medical history and on-going plans. We then work together to assess the baby and make sure they are well enough to be transferred before connecting them up to our monitors and other equipment that they need. If any procedures or tests are needed prior to transfer these are then done, keeping the family up to date. Sometimes we take a parent with us in the ambulance and sometimes they travel separately. We make sure we have contact information for parents so that we can update them when the transfer is complete. The NEST nurse and ANNP then sit in the back of the ambulance with the baby who will be in a transport incubator or pod. During the journey to the receiving unit regular observations are completed, responding to changes in the baby’s condition as needed. When we arrive at the receiving neonatal unit we then meet the new team and give a full handover, including how the patient has been during the transfer. If a family member is not present then we will also give them an update either by phone call or text message. We then return to base where we clean all the equipment and add the patient journey to our database.

Some of the transfers that the ANNP attends are not planned and we may be called to transfer a very sick infant at any time of day or night. These patients are referred to the NEST team via an emergency phone line, which is usually answered by the ANNP on duty. Details are taken from the referring neonatal unit about the patient by the ANNP and a transport consultant is added to the phone call so that they can offer advice and agree a plan of action with the rest of the NEST team. If the patient requires emergency retrieval so that it can receive specialist treatment or medications then the team dispatch from the base as quickly as possible, using a blue light ambulance to reduce the time taken to arrive at the patient’s bedside. The ANNP then works as a team with the nurse and consultant to deliver specialist treatments and therapies to the infant with the aim to stabilise them for transfer to a tertiary centre. Once the patient is as stable as possible they are carefully moved into our transport incubator system (an intensive care unit on wheels) and taken under blue light conditions to a specialist neonatal unit, or sometimes even theatre. The time we are at the referring unit can vary depending on how poorly the baby is or which treatments they need to get better. Sometimes we have to leave very quickly and there may be little time to speak to the family, but we will always keep parents up to date and where possible one will be able to travel with us. As with a planned transfer we will take contact details and give the receiving hospital a full handover about the patient.

Once any job is completed it is important that all members of the team involved de-brief about how the transfer went. This is important for team welfare as well as identifying any learning points or things that went particularly well.