Eligible patients for transfer will meet the Medical Criteria listed in one of the categories below:
1. Former ELBW s/p tracheostomy with or without requirement for chronic ventilation who is stable but not ready to be discharged home. Infant should be greater than 35 weeks CGA at the time of transfer
a. Vent settings have been consistent for a week or more – (LTV)
2. GA at birth >28 weeks, corrected to ≥ 35 weeks GA
a. Out of isolette with stable temperatures
i. In isolette WNL – i.e. bilibaby vs. micro w/temp issues
b. NG/OG/PO feeding
c. No concern with ongoing apnea/bradycardia events
d. No concern for ROP or ophtho follow up in house (post DC follow up is fine!)
3. Term infant
a. Term/late preterm w/hx fluids r/t hypoglycemia with glucose monitoring needs
b. NAS on maintenance dose of Morphine
c. Stable on IV antibiotics finishing course for sepsis, etc.
d. Readmission for hyperbilirubinemia no longer at risk for exchange transfusion
e. Surgical patient, stable from a cardiovascular standpoint, may have a PCVL and working on increasing enteral feeding or waiting for repeat surgery
i. No concern for unresolved airway issues/airway obstruction (i.e. TEF repair with events)
4. Other infants at discretion of attending teams
a. Surge situation should allow for discretion inclusive of A/B final spell count days or day prior to discharge home (not ideal r/t patient & parent satisfaction)
Patients meeting the above criteria should have the following discharge screenings/requirements completed prior to transfer:
· ABR hearing screen (CMV sent if infant fails x 2, outpatient BAER arranged and documented)
o b/c responsibility of neonatologist & sign out for follow up
· NYS metabolic screen
o NICU will send the final NMS prior to transfers to the floor; no need to routinely repeat on floor
§ Floor will only be requested to do a NMS if the result prior to transfer/at transfer is abnormal
· If abnormal result received the NICU medical team (receiving notification) will contact the covering MD if still inpatient
o Cortext to attending physician (listed in EMR)
§ If patient discharged at time of abnormal result returned to NICU medical team; will follow up with PMD per current processes
· Hep B
o AAP policy – patient should have at birth if stable; ELBW or low birth weight – should receive once stable – i.e. stable enough for floor, admin in NICU prior to transfer
· Follow up appointments made (except for PMD- if discharge timing unknown)
o Specialty appointments – cardiology/nephrology etc…
o ROP follow up process à
§ Transfer addendum/summary
· Synagis eligibility – work with DC planner to start paperwork
· Circumcision if eligible/appropriate
o Don’t delay transfer based on this; but try!
o As a reminder babies’ can get circ’ed when medically ready per neo team
o Circ flow has been developed to have these take place on J10 (will attach)
Checklist for transfer:
(Purple = RN; Blue = Provider; Green = Supervisor)
1. Infant meets medical criteria for transfer (takes place on rounds) à every day; not just surge J
a. This should be a daily discussion; not a surge process but a routine
b. Ask in Team Stepps
c. Charge RN share at 815 huddle “possible transferrable” number
d. Attending/fellow touch base with Charge RN/manager following rounds (11-1130 ish)
2. ABR
3. NYS metabolic screen
4. Hep B given
5. CCHD screening
6. Other vaccines up to date as applicable/synagis
7. Follow up appointments made and documented in transfer summary (neodata) and powerchart discharge tab
a. Include the suggested follow up (not yet made) and scheduled appointments in the powerchart discharge tab as well
8. Charge RN teletracking process – J10 primary location & targeted
a. Teletracking process not to be instituted UNTIL all screens and follow-up appointments are completed
9. Provider in NICU complete transfer summary
10. Bed then assigned by transfer center w/supervisor input
a. Preference day shift
b. Surge protocol off-shift
11. Bed assignment typically takes place after discharges and above steps are completed; assume afternoon unless told otherwise
a. This alert will come across on the pager (NICU, supervisor, floor & resident)
i. Future teletracking boards will show this J
12. Sign out to the appropriate resident based on bed assignment
13. Transfer order placed
14. RN to RN sign-out at bedside
Complicated/long NICU patient stays are not ideal candidates for transfer to the floor based on risk associated with multiple hand-offs. Especially if discharge anticipated in 24-48 hours.