Development of regional guidelines: the way forward for neonatal networks?

Within the United Kingdom, the recently published National Service Framework for Children’s Services argues that neonatal intensive care should be commissioned on a regional basis.^1,2 Until recently, neonatal intensive care was provided by individual NHS trusts working in an ad hoc manner to provide intensive care support for an often ill defined geographical area. Traditionally, smaller units referred unstable babies to a regional centre. The transport of these babies was again provided in an ad hoc manner, usually by a retrieval team made up of the on call doctor and nurse from the receiving hospital. District hospital clinicians often felt frustrated at the inconsistent stabilisation procedures requested by relatively inexperienced transport doctors. One of the aims of establishing managed clinical networks is to make the clinical service more equitable across several organisations and often a large geographical area. This can be achieved by clinicians and trusts working in partnership with a centralised transport team, agreed patterns of referral, and shared protocols, based on the best evidence. We here show that regional guideline development is an excellent tool to tackle the challenge of a variable evidence base and achieve unified neonatal practice, and can therefore facilitate a close partnership between all hospitals within a network.

Within the Yorkshire Neonatal Network (birth rate 39 000/year), we have recently successfully developed, implemented, and audited the Yorkshire region guideline for neonatal stabilisation before transfer. Our network consists of 12 hospitals, four of which provide level 3 neonatal intensive care. The guideline was developed on the basis of a process using transparent methodology, careful leadership, consultation, efficient communication, and good team work. As far as we are aware, this is the first regional neonatal network guideline within the United Kingdom.³ …