Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Tenwek Hospital and Tenwek School of Nursing, Bomet, Kenya.
Acta Paediatr. 2017 Oct;106(10):1666-1673. doi: 10.1111/apa.13940. Epub 2017 Jul 14.
The Helping Babies Breathe (HBB) programme is known to decrease neonatal mortality in low-resource settings but gaps in care still exist. This study describes the use of quality improvement to sustain gains in birth asphyxia-related mortality after HBB.
Tenwek Hospital, a rural referral hospital in Kenya, identified high rates of birth asphyxia (BA). They developed a goal to decrease the suspected hypoxic-ischaemic encephalopathy (SHIE) rate by 50% within six months after HBB. Rapid cycles of change were used to test interventions including training, retention and engagement for staff/trainees and improved data collection. Run charts followed the rate over time, and chi-square analysis was used.
Ninety-six providers received HBB from September to November 2014. Over 4000 delivery records were reviewed. Ten months of baseline data showed a median SHIE rate of 14.7/1000 live births (LB) with wide variability. Ten months post-HBB, the SHIE rate decreased by 53% to 7.1/1000 LB (p = 0.01). SHIE rates increased after initial decline; investigation determined that half the trained midwives had been transferred. Presenting data to administration resulted in staff retention. Rates have after remained above goal with narrowing control limits.
Focused quality improvement can sustain and advance gains in neonatal outcomes post-HBB training.
众所周知，“帮助婴儿呼吸”（HBB）计划可降低资源匮乏环境下的新生儿死亡率，但护理方面仍存在差距。本研究描述了如何利用质量改进来维持 HBB 后与出生窒息相关的死亡率降低的成果。
肯尼亚的农村转诊医院 Tenwek 医院发现出生窒息（BA）发生率较高。他们制定了一项目标，即在 HBB 后六个月内将疑似缺氧缺血性脑病（SHIE）的发生率降低 50%。他们使用快速变革周期来测试干预措施，包括对员工/学员进行培训、保留和参与，以及改进数据收集。运行图随时间跟踪该比率，使用卡方分析。
96 名提供者于 2014 年 9 月至 11 月接受了 HBB。审查了 4000 多份分娩记录。基线数据的 10 个月显示，SHIE 率中位数为 14.7/1000 活产（LB），变化幅度较大。HBB 后 10 个月，SHIE 率下降了 53%，降至 7.1/1000 LB（p=0.01）。在最初下降后，SHIE 率有所上升；调查确定，一半受过培训的助产士已被调走。向管理层展示数据导致员工保留。此后，由于控制限变窄，该比率一直保持在目标之上。
集中的质量改进可以维持和推进 HBB 培训后新生儿结局的改善。
