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Remote Mentorship to Improve Continuous Positive Airway Pressure Use in the Ethiopian Neonatal Network
Danielle E Y Ehret1,2, Bogale Worku3, Asrat Demtse4
1University of Vermont Larner College of Medicine, Burlington, Vermont.
Insights
Remote mentorship improved continuous positive airway pressure (CPAP) use for preterm infants with respiratory distress syndrome (RDS). This quality improvement initiative significantly reduced preterm mortality in Ethiopian hospitals.
Area of Science:
- Neonatal Medicine
- Quality Improvement Science
- Global Health Equity
Background:
- Respiratory distress syndrome (RDS) is a primary cause of mortality in preterm infants globally.
- A quality gap in the utilization of continuous positive airway pressure (CPAP) for RDS in preterm infants was identified in Ethiopia.
- The Ethiopian Neonatal Network (ENN) aimed to enhance CPAP use through remote education and mentorship.
Purpose of the Study:
- To implement and evaluate a telementoring program to improve CPAP use in preterm infants with RDS.
- To assess the impact of remote mentorship on CPAP delivery and preterm infant mortality.
- To determine if quality improvement initiatives can be effective without additional resource allocation.
Main Methods:
- A quality improvement collaborative involving 19 public ENN hospitals from September 2021 to September 2022.
- Implementation of a telementoring program where 5 mentor pairs supported 4 mentee hospitals each.
- Data collection on neonatal unit admissions, monthly audits, and use of run chart rules; pre- and post-intervention preterm mortality analyzed using a χ2 test.
Main Results:
- The quality improvement collaborative led to increased documentation of respiratory distress assessments (Downes score) from 57.8% to 95.6%.
- The number of preterm infants receiving CPAP increased monthly from 129 to 138.
- Preterm mortality significantly decreased from 28% preintervention to 21.6% postintervention (P < .0001).
Conclusions:
- Remote nurse-physician mentorship effectively standardized respiratory distress assessments and optimized CPAP use in preterm infants.
- The initiative resulted in a significant reduction in preterm mortality, demonstrating the potential for scalable CPAP optimization.
- This approach offers a viable strategy for improving neonatal care in resource-limited settings.
Background:
Continuous positive airway pressure (CPAP) is an evidence-based therapy for respiratory distress syndrome (RDS), the leading cause of death for preterm infants globally. Ethiopian Neonatal Network (ENN) teams identified a quality gap in CPAP use for preterm infants with RDS. We sought to use remote education and mentorship without additional resources to improve CPAP use in this population.
Methods:
Nineteen public ENN hospitals participated in this quality improvement (QI) collaborative (September 2021 to September 2022). The primary intervention was implementation of a telementoring program. Five Ethiopian nurse-physician mentor pairs each supported 4 mentee hospitals through a remote CPAP optimization training package. Quarterly ENN collaborative meetings reviewed progress and challenges. Hospitals submitted patient-level data for all neonatal unit admissions and monthly audits. Run chart rules were used to assess for nonrandom evidence of change related to CPAP use. Preterm mortality in preintervention and postintervention periods was evaluated by a χ2 test.
Results:
The launch of the QI collaborative with remote education and mentoring coincided with an increase in the documentation of Downes score on admission (57.8% to 95.6%) and number of preterm infants (<37 weeks' gestation) receiving CPAP (129 to 138 per month). Preterm mortality decreased significantly from preintervention (28%) to postintervention periods (21.6%) (P < .0001).
Conclusion:
Ethiopian nurse-physician mentorship pairs supporting mentee hospitals in standardizing assessments of respiratory distress and optimizing the use of CPAP increased the number of preterm infants treated with CPAP. Significant reduction in preterm mortality postintervention is encouraging as CPAP use continues to scale up globally.
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