Annex A > Chapter 13 - Pre-operative Care > The transfer of children from referring hospitals
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The transfer of children from referring hospitals
1 The detail of the way in which children came to be referred and transferred to Bristol from outreach clinics and generally is set out earlier in Chapter 10 - Outreach Cardiology Clinics and Chapter 11 - Referrals.
2 Dr Hyam Joffe and Dr Stephen Jordan, consultant cardiologists, explained that during the period of the Inquiry's Terms of Reference, children would be transferred from referring hospitals to the BRHSC where they were admitted and evaluated. [1]
`Occasionally, where it proved quite impossible to admit the infant to BRHSC a cardiologist would go (with an echo-machine if necessary), to an outlying hospital to see the infant and start the process of diagnosis and treatment.' [2]
4 However, the general procedure was that, prior to the transfer, the referring clinician would discuss the child's condition by telephone with one of the Bristol cardiologists who were available on a 24-hour basis [3] and would explain the practicalities of the transfer. Dr Jordan told the Inquiry:
`The usual procedure throughout this time was that the referring paediatrician and the cardiologist would discuss the patient's condition by phone and a decision would be made as to the best method of transfer. (In addition, any other treatment, such as the start of prostaglandin infusion or a dopamine infusion, could be considered.) In most cases transfer was with the infant being accompanied by one of the referring paediatric team, usually a senior registrar, and an experienced nurse. If the infant was already on a ventilator it could be that this team, plus one of the local anaesthetists, would bring the infant, but more usually the BRHSC would send a team, usually with a consultant anaesthetist and a senior nurse and a transport incubator with a ventilator would go from Bristol to collect the infant (sometimes described as a "scoop"). In addition, the neonatal unit at St Michael's Hospital across the road also had a "scoop" facility and in case of difficulty they would send their team for new born infants ...
`In most instances the transfer was by ambulance, which was reasonably quick as most of the referring hospitals were very close to the M5/M4 network. Patients from Truro more commonly came by air ambulance ... to be met by an ambulance. The sophistication of this transfer service increased over the years concerned. In particular we gave increasing attention to stabilising the infant as far as possible before transfer. Occasionally a cardiologist went with the "scoop" team, but this potentially left a period of several hours without cover in Bristol and the cardiologist probably had less to contribute than an anaesthetist.' [4] [5]
5 Dr John Laband, a junior doctor at the BRHSC from November 1994 to January 1995, confirmed in a letter to the Inquiry:
`We were the first contact with medical staff for parents of babies undergoing heart surgery, the patients first being admitted to the Children's Hospital before being transferred to the Bristol Royal Infirmary usually over the weekend.' [6]
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Footnotes
[1] Although Dr Joffe explained: `Prior to the opening of the BCH cardiac catheterisation laboratory in 1987, a few babies were initially examined by a paediatric cardiologist in the Bristol maternity units, i.e. Southmead or Bristol Maternity hospitals, and then transferred ...' See WIT 0097 0295 Dr Joffe
[2] WIT 0099 0039 Dr Jordan
[3] WIT 0097 0295 Dr Joffe
[4] WIT 0099 0039 Dr Jordan
[5] Dr Joffe explained: `A specialised intensive care ambulance based at the paediatric intensive care unit ... at BCH, and staffed by intensivists, only became available after 1995'. See WIT 0097 0295 - 0296 Dr Joffe
[6] INQ 0042 0004; letter from Dr Laband