Research and Publications

Research, Governance, Audit and Publications

Clinical Governance is a process of continuously improving the quality of their services and maintaining high standard of care by creating an environment in which clinical excellence can be developed. (Guidance on Clinical Governance, GOV.UK). One of the key pillars of Clinical Governance is clinical effectiveness and research. Hence, research and quality improvement are viewed highly in London NTS. We currently have 6 ongoing quality improvement projects aiming to deliver safe and effective services as a transport team, and assisting other NICUs in London to providing evidence-based medical treatment to our babies.

Those 6 projects are:

CoolTriP

An ongoing quality improvement project on standardising decision making on neonatal therapeutic cooling treatment across London. The pathway of the CoolTriP can be found on London Neonatal Operational Delivery website (https://www.londonneonatalnetwork.org.uk/wp-content/uploads/2021/05/CoolTriP-pathway-14.pdf)

Bilibear

A prospective data collection looking at the presentation of babies who present with bilious vomiting. It aims to see if the colour of bile or other aspects of the history can predict if there is significant surgical pathology or a medical cause for the bilious vomit or aspirate.

SurgiNec

Another prospective data collection aiming to establish factors predicting whether a baby with NEC (necrotizing enterocolitis) requires surgical intervention. The data collection includes blood results (such as lowest WBC, Platelets, Albumin, CRP and lactate) and all abnormal systematic, abdominal and radiological findings. One of the aims of the study is ensure babies who are likely to need surgical intervention are transferred surgical centres.

Pain Project

An ongoing quality improvement project looking at use of a pain assessment tool to ensure that all babies being transferred are reviewed for signs of pain and treated appropriately. It started with a focus on babies being transferred post-operatively but has been extended to all emergency transfers including babies who are ventilated, preterm and undergoing therapeutic hypothermia. The assessment is conducted using the PIPP-R scoring system at 3 different time points: a baseline measure at the referring unit, during handling and on arrival at the accepting unit. If an intervention was done, baby will need to be reassessed. We are also exploring the practices of transport units throughout the country.

Difficult Airway

This ongoing quality improvement project is implementing a Difficult Airway guideline and pathway for the NTS teams to follow, including the use of new equipment. As this becomes imbedded in our team we shall support the other neonatal units in our area to develop protocols and guidelines for managing difficult airways in their own settings.

PremWarm – Preterm Servo-Controlled Thermoregulation

A quality improvement project on monitoring the effectiveness and adverse effects of themoregulating preterm babies (up to 32 weeks gestation) using Tecotherm and Therm Aqua Pad mattresses. The eligibility criteria for participation are as follow:

<32 weeks gestation OR < 1 kg
<14 days old
Transfer for uplift of care.

Journal articles published by NTS staff

Outcomes of full-term infants with bilious vomiting: observational study of a retrieved cohort

Syed Mohinuddin, Pankaj Sakhuja, Benjie Bermundo, Nandiran Ratnavel, Stephen Kempley, Harry C Ward, Ajay Sinha

Arch Dis Child 2015;100:14-17 doi:10.1136/archdischild-2013-305724