Developing governance structures within a new retrieval service in North East London

ABSTRACT

The North East London Critical Care Transfer And Retrieval (NECCTAR) service was created in December 2020 in response to rapidly increasing pressures on critical care resources due to the COVID-19 pandemic [1]. The service was developed to lead capacity-related transfers within the region, providing a dedicated, skilled service at a time of unprecedented demand. It evolved to support longer-distance transfers across the nation. The model comprises a consultant, registrar, nurse/anaesthetic assistant and London Ambulance Service crew. With rotating teams performing complex inter-hospital transfers, a robust governance process was essential to maintain patient safety. Methods Existing pre-hospital expertise within the nascent service was leveraged to generate a hybrid governance model. Case analysis comprised the first layer. All cases underwent consultant review, which provided targeted feedback. Specific cases were highlighted at governance meetings with multidisciplinary scrutiny and discussion encouraged. Emergent themes guided service development with feedback disseminated at subsequent meetings. The second aspect was incident reporting. Datix was used as per Trust guidelines and a NECCTAR event report form was developed to capture lower risk 'lessons learnt' into horizontal themes for quicker dissemination. Results Open governance meetings were conducted monthly during the pandemic, with high attendance. The entire patient journey was reviewed, alongside technical, human and system factors. Discussions led to improvements in the referral process, acceptance criteria, equipment provision and management of declined transfers, and explored ethical considerations. Standard operating procedures and existing on-board training were revised. Documentation assessment has shaped a new electronic transfer record. Meetings have incorporated expert teaching on complex airways, arrhythmias and cardiogenic shock. The governance process itself was adapted to allow best reporting. Discussion Pandemic conditions did not prove a barrier to methodical capability development, nor robust governance. The process has presented an invaluable opportunity for team-wide learning through shared experience. The model has been continuously developed to disseminate learning to every team member and has informed patient safety as well as service development. The hybrid structure, with combination of case review and reporting systems, is sustainable, inclusive and generalisable.