Well baby transports

RNtoNNP, BSN, DNP, APRN · Jun 19, 2017

In my area transports are done only if there is a medical need. If babies are transported to our level III NICU, they stay there until discharge, and if we transfer a baby to a level IV NICU, that baby will stay at that hospital until ready for discharge as well. We recently had to send a baby to another hospital for a PDA ligation while his twin brother remained in our NICU. Once the baby had the surgery and was stabilized, we started trying to figure out a way to get him reunited with his brother. We couldn't send his brother to the other hospital because there was no medical reason for him to need their higher level of care, and the baby couldn't be transferred back to our hospital because, again, there was no medical reason for him to come back so insurance wouldn't cover it. Our hospital has a charity fund to help pay for things like this, but we couldn't use that because our hospital would be making money off his transfer back to us. Basically, the hospital couldn't use it's charity money for something that would bring in more money in return. We did finally get him back to us by finding a charity air ambulance service, but it took quite a while to get all of that sorted out. I believe that this is why we don't transfer babies back to their community hospitals once they no longer need "NICU" services. I would be very surprised if insurance companies would pay for that transport because there would be no medical reason. It's interesting that your hospital does well-baby transports!

babyNP., APRN · Jun 20, 2017

It's variable based on region. In response to RNtoNNP, in my own experience, there are a lot of community hospitals that will pay for the cost of the transport because once they get the baby back, they get all the revenue from the insurance company since NICU patients are cash cows for the hospital (often supporting the hospital's budget significantly). The cost of the transport is then recouped by the patient's continued stay at the community hospital.

There are also insurance companies that will pay for transport if the regional hospital isn't "in-network" and therefore they save themselves money by transporting the baby back to the community hospital where the costs are much lower.

To be frank, most of the Level IV NICUs with which I've been associated (either as a RN, NNP, or student) were always full to bursting and looked to transporting out convalescent patients frequently. There were quite a few parents who did not appreciate this at all as they liked the private rooms and higher level of care, but it was explained to them that we didn't want to not have an open bed for an infant was critically ill and couldn't go elsewhere...

RNtoNNP, BSN, DNP, APRN · Jun 20, 2017

There are also insurance companies that will pay for transport if the regional hospital isn't "in-network" and therefore they save themselves money by transporting the baby back to the community hospital where the costs are much lower.

I find it interesting that this is so different in other areas! We had another set of twins once who were brought to our hospital because mom delivered while on vacation nearby and our hospital was the closest level III. Once the babies were stable, the parents wanted them transferred to a level III NICU closer to their home, but the insurance company wouldn't cover it even though our hospital was out-of-network. We all thought that the cost of keeping the babies at an out-of-network hospital for several months (they were pretty little at birth) would cost more than covering the transport, but the insurance company didn't go for it. Thanks for your post babyNP! I wasn't aware that these policies were so different in other parts of the country.

prmenrs, RN · Jun 20, 2017

I did a lot of these transports. Several reasons were the impetus: insurance often wanted the baby back @ "their" hospital; sometimes, the original private pediatrician resented having their pt 'poached' by the tertiary hospital, wanted them back to review the hospital course, re-assume care, re-establish a relationship w/the family; and lastly, to get the patient closer to home to make it easier for mom and dad.

The nurse caring for the baby (if s/he was qualified for transport, which most of our nurses are) would take the baby, w/just the ambulance crew. More than once we transported kids > 100 miles, so that was basically your assignment all shift. If staffing was tight, a nurse could come in, do the transport and then go home herself.

So, it is done. I hope that answers your question.

vintage_RN, BSN, RN · Jun 20, 2017

All this insurance stuff is making my head spin! I'm in Canada - so publically funded :) I find it's very unfortunate in some situations what my centre has to do...as we are the tertiary centre we need to accept the sickest babies in our area...which means we are always in a crunch to ship stable babies out. Sometimes that means deciding to ship a baby out on very short notice as we only find out if beds are available last minute. 2 instances this past weekend were 1. I was told baby was being sent to a community hospital about 30 mins away, called parents to let them know and parents called back freaking saying they had all these unaddressed concerns from OT/dietary..of course I was in the line of fire. And then yesterday I took a baby to a hospital about 20 min away and parents are very young with no transportation, but live in my city. We had to transfer the baby due to bed crunches. Parents weren't happy - and I had to get charge involved. And I see their point - how are they going to get there? We obviously try not to do that and take those things into consideration but we are so pressed for our critical care beds that we really have no choice but to push well babies out. We do keep our chronic and complicated ex prems and any other complicated babies.

ScammRNC · Jun 20, 2017

We only do these kind of "back" transports if out unit is full and potentially going on diversion. But if they take place, out transport team is responsible for doing the transport.