Datta Vikram, Saili Arvind, Goel Srishti, Sooden Ankur, Singh Mahtab, Vaid Sonali, Livesley Nigel
Department of Neonatology, Kalawati Saran Children's Hospital, Lady Hardinge Medical College, New Delhi, India.
University Research Co., LLC, Chevy Chase, Maryland, USA.
BMJ Open Qual. 2017 Nov 20;6(2):e000183. doi: 10.1136/bmjoq-2017-000183. eCollection 2017.
Neonatal hypothermia is a common and dangerous condition around the world. 70% of neonates born in Kalawati Saran Children's Hospital in New Delhi, India, and subsequently admitted to the neonatal intensive care unit (NICU) had a temperature below 36.5°C on admission. In July 2016, we formed a team of staff from the labour room, NICU and auxiliary staff to reduce hypothermia in babies transported to our NICU using quality improvement methods. We identified problems related to staff awareness of hypothermia and its dangers, environmental factors and supply issues in the labour room, and challenges with rapidly and safely transferring sick newborns to the NICU. We used the Plan-Do-Study-Act cycles to test and adapt solutions to these problems. Because infection is a common complication of hypothermia, we also instituted a training programme to improve handwashing skills among parents and health workers. Within 9 months of starting our quality improvement project, the proportion of neonates who were normothermic on admission increased from 27% to 75%, the number of cases of late-onset neonatal sepsis decreased from 15.2 to 5 cases/1000 patient days, and all-cause mortality fell from 4.2 to 2.6 neonatal deaths per week. Multiple factors can lead to neonatal hypothermia, and the most important factors will differ from facility to facility. Quality improvement methods provide health workers with the skills to identify the key factors contributing to hypothermia in their facility and to develop strategies to address them. Addressing processes of care can lead to improved thermal care and save lives.
新生儿低体温是全球常见且危险的病症。在印度新德里的卡拉瓦蒂·萨兰儿童医院出生并随后入住新生儿重症监护病房（NICU）的新生儿中，70%在入院时体温低于36.5°C。2016年7月，我们组建了一支由产房、NICU工作人员及辅助人员组成的团队，运用质量改进方法来降低转运至我们NICU的婴儿的低体温情况。我们识别出了与工作人员对低体温及其危险的认知、产房的环境因素和供应问题相关的问题，以及将患病新生儿快速安全转运至NICU所面临的挑战。我们采用计划-执行-研究-行动循环来测试并调整针对这些问题的解决方案。由于感染是低体温的常见并发症，我们还开展了一项培训计划，以提高家长和医护人员的洗手技能。在启动质量改进项目的9个月内，入院时体温正常的新生儿比例从27%增至75%，晚发性新生儿败血症病例数从每1000个患者日15.2例降至5例，全因死亡率从每周4.2例新生儿死亡降至2.6例。多种因素可导致新生儿低体温，且最重要的因素因机构而异。质量改进方法为医护人员提供了技能，以识别其机构中导致低体温的关键因素，并制定应对策略。改进护理流程可改善体温护理并挽救生命。
