All about transfer to level II

• Level III, may also be called tertiary care. This is the highest level of care reserved for the sickest babies in Ontario. There are 8 of these units in Ontario. Sunnybrook is a level IIIa NICU.
• Level II, including three levels: IIA, IIB, and IIC. Level II units are located in most large community hospitals. They care for babies less ill and those recovering from level III care but not quite ready to be discharged home. Babies are transferred to a level II unit as part of the regionalized system of maternal newborn care in Ontario.
• Level I. Level I units are located in smaller hospitals and care for low risk mothers and babies. Most babies stay with their mothers throughout their hospital stay.

Transfer is a requirement from Ontario’s Ministry of Health and Long-Term Care to ensure that everyone can have the appropriate level of care when they need it. All Intensive Care Units must transfer patients to a different level of care once the patient is assessed to be stable by the health care team. Transfer in the NICU will be decided based on some of these factors:

• Age and weight
• Cardio-respiratory status
• Growth
• Nutritional status
• Access (venous and arterial)
• Treatment, tests and procedures

Other factors will also be considered and this list is not exclusive so please feel free to discuss with any member of the team.

Conversations will occur around transfer early and often during your stay. Please tell the team about your preferences and your concerns. You will be informed the day of the transfer of the availability of a bed at a level II and the planned time of transfer. We will make every attempt to give you as much notice as possible but this may not be feasible if there is an urgent need for the NICU bed.

If you want to learn more about transfer in Ontario’s NICUs you can visit the website of the Provincial Council for Maternal and Child Health.

All of the babies transferred to a level II NICU from Sunnybrook will be accompanied by a Sunnybrook nurse. Ask the staff if you will be able to accompany your baby in the transport vehicle. They will go in a transport incubator, secured by blanket rolls and a safety harness. They will be monitored the entire time and the monitoring system has alarms to alert the nurse of any change in vital signs.

The doctor or nurse practitioner responsible for your baby’s medical needs will call the doctor at the receiving facility and tell them about your baby’s care. The charge nurse will also call ahead and speak to the charge nurse in the other NICU. The nurse accompanying your baby will speak to the receiving nurse when your baby arrives at the facility. You and the other center’s medical team will receive a discharge summary that describes your baby’s course of treatment in Sunnybrook’s NICU.

You can also learn more about level II by taking a brochure or by calling one of the level IIs and asking them the for the following information:

1. Map and directions to the hospital.
2. Parking (& cost of parking) and public transit information.
3. Time period that parents can be with their baby, handwashing and gowning guidelines.
4. Who can come into the unit with me when my baby arrives?
5. Are breast pumps available to use or rent?
6. Are care-by-parent and rooming-in facilities available?

This is what it may look like when babies are transferred:

• Level IIs may look different than the NICU at Sunnybrook, but your baby will still receive excellent care.
• Your baby will be on isolation precautions, not because they are sick, but because they came from a different hospital. This is a province-wide requirement when transferring any patient, of any age, between hospitals. Infection control procedures may be different because babies are older and more stable in level II NICUs.
• Schedules for tests may be different, but your baby will still receive the necessary tests for their safety and health.
• Expectations for parental involvement in care may be different. Ask the staff in the level II about how you can be more involved with your baby, and describe some of the care you already know how to do.