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A Quality Improvement Initiative for Early Initiation of Emergency Management for Sick Neonates
Asim Mallick1, Mukut Banerjee2, Biswajit Mondal1
1Department of Pediatrics, Nilratan Sircar Medical College and Hospital, Kolkata, India.
Insights
Point-of-care Quality Improvement (POCQI) significantly improved early emergency treatment for sick newborns. This approach increased timely interventions, reducing mortality and the need for ventilator support in neonatal care.
Area of Science:
- Neonatal Medicine
- Healthcare Quality Improvement
- Emergency Pediatrics
Background:
- Timely emergency treatment is critical for sick neonates.
- Early initiation of care can significantly impact neonatal outcomes.
- Existing care pathways may have delays in emergency treatment initiation.
Purpose of the Study:
- To evaluate the effectiveness of Point-of-care Quality Improvement (POCQI) in achieving early emergency treatment (within 30 minutes) for sick neonates.
- To assess the impact of a stepwise Plan-Do-Study-Act (PDSA) approach on treatment initiation times.
Main Methods:
- A 20-week quality improvement project was conducted in a Special Newborn Care Unit (SNCU).
- A stepwise PDSA methodology was employed over three cycles to optimize treatment initiation.
- Data were collected on consecutive sick neonates presenting during morning shifts.
Main Results:
- The percentage of neonates receiving treatment within 30 minutes increased from 20% at baseline to 76% post-intervention (P<0.001).
- Mean treatment initiation time decreased from 80.8 minutes to 19.8 minutes (P<0.001).
- Hospital mortality decreased from 33% to 15% (P=0.004), and ventilator support needs dropped from 44% to 18% (P<0.001).
Conclusions:
- Stepwise implementation of PDSA cycles effectively enhanced early emergency management for sick newborns.
- POCQI is a valuable strategy for improving timely interventions in neonatal emergency care.
- Early emergency management significantly improved survival rates and reduced the need for critical interventions.
Objective:
To determine efficacy of Point-of-care Quality improvement (POCQI) in early initiation (within 30 minutes) of emergency treatment among sick neonates.
Design:
Quality improvement project over a period of twenty weeks.
Setting:
Special Newborn Care Unit (SNCU) of a tertiary care center of Eastern India.
Participants:
All consecutive sick neonates (≥ 28 wk gestation) who presented at triage during morning shift (8 am to 2 pm).
Intervention:
We used a stepwise Plan-do-study-act (PDSA) approach to initiate treatment within 30 min of receiving sick newborns. After baseline phase of one month, a quality improvement (QI) team was formed and conducted three PDSA cycles (PDSA I , PDSA II and PDSA III) of 10 d each, followed by a post-intervention phase over 3 months.
Main Outcome Measure(S):
Percentage of sick babies getting early emergency management at SNCU triage.
Results:
309 neonates were enrolled in the study (56 in baseline phase, 88 in implementation phase and 212 in post- intervention phase). Demographic characteristics including birthweight and gestational age were comparable among baseline and post intervention cohorts. During implementation phase, successful early initiation of management was noted among 47%, 69% and 80% neonates following PDSA I, PDSA II and PDSA III, respectively. In comparison to baseline phase, the percentage of neonates receiving treatment within 30 minutes of arrival at triage increased from 20% to 76% (P<0.001) and the mean (SD) time of initiation of treatment decreased from 80.8 (21.0) to 19.8 (5.6) min (P<0.001) during post-implementation phase. Hospital mortality (33% vs 15%, P=0.004) and need for ventilator support (44% vs 18%, P<0.001) were also significantly lower among post intervention cohort in comparison to baseline cohort.
Conclusion:
Stepwise implementation of PDSA cycles significantly increased the percentage of sick newborns receiving early emergency management at the SNCU triage, thereby resulting in better survival.
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