Improving Rates of Delayed Cord Clamping in Ethiopian Hospitals: A Virtual Quality Collaborative

Area of Science:

• Neonatal care
• Quality Improvement (QI)
• Global Health

Background:

• Existing QI curricula often lack sustained mentorship for global implementation.
• The ECHO methodology offers a framework for remote learning and support.
• Delayed cord clamping (DCC) is a key component of essential newborn care.

Purpose of the Study:

• To implement a QI program using the ECHO methodology to improve DCC rates.
• To establish a learning community for ongoing mentorship and support in QI practices.
• To assess the feasibility and impact of a virtual QI initiative in a low-resource setting.

Main Methods:

• The Ethiopian Neonatal Quality Improvement (EN-QI) Project involved 8 delivery centers.
• Monthly virtual QI training sessions and site-specific progress tracking were conducted.
• SMART aims were set for DCC improvement, with outcomes analyzed using control charts.

Main Results:

• Initial DCC rates varied widely (7%-72%), with most sites below 50%.
• Within six months, 7 of 8 sites exceeded 50% DCC.
• The project culminated in an overall DCC rate exceeding 90% across over 3500 deliveries.

Conclusions:

• A remote, virtual, peer-led QI initiative effectively increased DCC rates in Addis Ababa.
• Local QI teams successfully adopted and sustained DCC practices.
• The EN-QI model shows promise for other QI initiatives in low-resource environments.