Although it is common practice for the level III neonatal intensive care unit (NICU) to reverse transfer infants to a lower level of care after stabilisation, there exist no simple tools to facilitate this process. The physical facilities, equipment, personnel and experience of level I and II centres vary widely, particularly those in level I community hospitals.

We performed a survey of all hospitals in our region (18 in all). The survey was sent to the nurse manager of the nursery (or combined postpartum nursery floor where available). We received 100% returns to the survey. The survey suggested that the ability of our 13 community hospitals to receive reverse transfers was determined by only 6 treatment criteria - ability to deliver oxygen, ability to monitor oxygen, ability to perform IVs, ability to provide naso-gastric feeds, ability to monitor heart rate and respirations, ability to treat apneic spells (baby on methylxanthine) - plus gestational age and weight at proposed time of transfer.

We then designed a simple tool which allows the needs of newborns who are potential reverse transfers to be compared with the availability of needed services in the hospitals being considered to receive the infant. In the event of a `match', the reverse transfer is initiated. If the hospital is unable to receive the infant, the tool allows choice of another hospital or suggests what particular need will have to be met before transfer can be accomplished.

Evaluation of use of the tool since its introduction suggests that it is easy to understand and use. However, NICUs vary in how often they use the tool itself, since its introduction has led to better knowledge of services available in the community hospitals, thus reducing reliance on the tool itself over time.

We shall demonstrate how the tool is used in practice, as well as how it can be adapted to the particular characteristics of hospitals in any region.