一项针对患病新生儿早期启动应急管理的质量改进倡议。

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

作者信息

Mallick Asim, Banerjee Mukut, Mondal Biswajit, Mandal Shrabani, Acharya Bina, Basu Biswanath

机构信息

Department of Pediatrics, Nilratan Sircar Medical College and Hospital, Kolkata, India.

Department of Pediatrics, Nilratan Sircar Medical College and Hospital, Kolkata, India Correspondence to: Dr Mukut Banerjee, Assistant Professor, Department of Pediatrics, Nilratan Sircar Medical College and Hospital, Kolkata, India.

出版信息

Indian Pediatr. 2018 Sep 15;55(9):768-772.

PMID:30345982

Abstract

OBJECTIVE

To determine efficacy of Point-of-care Quality improvement (POCQI) in early initiation (within 30 minutes) of emergency treatment among sick neonates.

DESIGN

Quality improvement project over a period of twenty weeks.

SETTING

Special Newborn Care Unit (SNCU) of a tertiary care center of Eastern India.

PARTICIPANTS

All consecutive sick neonates (≥ 28 wk gestation) who presented at triage during morning shift (8 am to 2 pm).

INTERVENTION

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.

MAIN OUTCOME MEASURE(S): Percentage of sick babies getting early emergency management at SNCU triage.

RESULTS

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.

CONCLUSION

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.

摘要

目的

确定即时质量改进（POCQI）在患病新生儿紧急治疗早期启动（30分钟内）中的效果。

设计

为期二十周的质量改进项目。

地点

印度东部一家三级医疗中心的特殊新生儿护理单元（SNCU）。

参与者

所有在早班（上午8点至下午2点）分诊时就诊的连续患病新生儿（孕周≥28周）。

干预措施

我们采用逐步的计划-实施-研究-改进（PDSA）方法，在接收患病新生儿后30分钟内启动治疗。在为期一个月的基线期后，成立了一个质量改进（QI）团队，并进行了三个为期10天的PDSA循环（PDSA I、PDSA II和PDSA III）；随后是为期3个月的干预后阶段。

主要观察指标

SNCU分诊时接受早期紧急处理的患病婴儿百分比。

结果

309名新生儿纳入研究（基线期56名，实施期88名，干预后期212名）。基线期和干预后队列的人口统计学特征（包括出生体重和孕周）具有可比性。在实施阶段，PDSA I、PDSA II和PDSA III后，分别有47%、69%和80%的新生儿成功实现早期管理启动。与基线期相比，干预后期分诊后30分钟内接受治疗的新生儿百分比从20%增至76%（P<0.001），治疗启动的平均（标准差）时间从80.8（21.0）分钟降至19.8（5.6）分钟（P<0.001）。与基线队列相比，干预后队列的医院死亡率（33%对15%，P=0.004）和呼吸机支持需求（44%对18%，P<0.001）也显著降低。