Towards a safer and more efficient neonatal transfer system in South Africa : a qualitative inquiry with advanced life support paramedics

Abstract

Introduction The inter-healthcare transfer of the critically ill neonate is a critical aspect of larger neonatal intensive care, as it influences the safe transport of neonates from the receiving to the referring hospital. It is crucial then that the transfer process be safe and efficient so as not to compromise the already fragile condition of the neonate. The aim of the study was to understand the challenges advanced life support (ALS) paramedics face during neonatal transfers and to understand how the process could be made safer and more efficient. The objectives related to understanding the transfer process, the challenges linked to the critically ill neonate and the difficulties associated with the ambulance vehicle and equipment. Methods Using a qualitative research approach we sought the views of ALS paramedics at the forefront of transfers nationally. In-depth interviews were held with eight paramedics in KwaZulu-Natal and four focus group discussions with ALS paramedics in KwaZuluNatal, Gauteng, Free State and the Western Cape in South Africa. A total of 35 ALS paramedics were involved in these group discussions. Results The study uncovered several challenges that paramedics face related to poor organisational preparation for transfer of the critically ill neonate, and other crucial issues that compromise the transfer such as inadequate or defective equipment. Conclusion There is a need for greater scrutiny of the transfer process and a commitment from stakeholders to begin addressing the challenges confronting the safe transfer of critically ill neonates.