A Quality Improvement Initiative for Early Initiation of Emergency Management for Sick Neonates

Abstract

To determine efficacy of Point-of-care Quality improvement (POCQI) in early initiation (within 30 minutes) of emergency treatment among sick neonates. Quality improvement project over a period of twenty weeks. Special Newborn Care Unit (SNCU) of a tertiary care center of Eastern India. All consecutive sick neonates (≥ 28 wk gestation) who presented at triage during morning shift (8 am to 2 pm). 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. Percentage of sick babies getting early emergency management at SNCU triage. 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. 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.