Maternity, Hopital Universitaire de Mirebalais, Mirebalais, Haiti
Medical Direction, Hopital Universitaire de Mirebalais, Mirebalais, Haiti.
BMJ Open Qual. 2023 Jan;12(1). doi: 10.1136/bmjoq-2022-001879.
Following the first COVID-19 peak in 2020, came the seasonal childbirth peak at Hôpital Universitaire de Mirebalais (HUM). This peak is associated with overcrowding on the labour and delivery (L&D) ward. Lack of sufficient bed-space for sick neonates in the neonatal ICU at HUM, has led to overcrowding and lengthy stays of sick newborns on L&D. These conditions contribute to the subsequent lack of bed-space for newly postpartum mothers and potentially decreases quality of care for both new mothers and neonates.
A Maternity Task Force was created by hospital leadership to address these urgent needs. The team's objective was to eliminate mothers and newborns laying on the floor in L&D. The Six-Sigma/DMAIC quality improvement methodology was used as the problem was urgent, demanded rapid results and centred around the process of patient flow in the institution. Process flow chart and Ishikawa diagrams were used to identify the root causes of the issues.
An average of 22% of postpartum women did not have a bed preintervention and 0% of postpartum women were laying on the floor post intervention. An average of 33% of newborns received paediatric care on the maternity ward pre-intervention compared with an average of 17% postintervention. The team did not achieve its objective for this second indicator, which was to have less than 10% of sick newborns on the maternity ward receiving paediatric care.
HUM hospital leadership took the vital decision to form the Maternity Task Force to make changes, which consequently led to a sustainable positive and lasting impact on the lives of new mothers and their babies at the institution. The objective of 0 postpartum mothers and newborns on the ground was achieved and fewer newborns receive intensive paediatric care on the maternity ward as a result of our interventions.
2020 年首次出现 COVID-19 高峰后，米雷博瓦勒大学附属医院（HUM）迎来了季节性生育高峰。这一高峰与分娩病房（L&D）过度拥挤有关。HUM 的新生儿重症监护病房（NICU）中用于患病新生儿的床位不足，导致患病新生儿在 L&D 过度拥挤且逗留时间延长。这些情况导致随后新产后母亲缺乏床位，并可能降低新母亲和新生儿的护理质量。
医院领导层成立了一个产科特别工作组来解决这些紧急需求。该团队的目标是消除 L&D 中躺在地板上的母亲和新生儿。六西格玛/DMAIC 质量改进方法被用于解决这个问题，因为问题紧急，需要快速结果，并且围绕着医院的患者流程。过程流程图和石川图被用于确定问题的根本原因。
干预前，平均有 22%的产后妇女没有床位，干预后，没有产后妇女躺在地板上。干预前，平均有 33%的新生儿在产科病房接受儿科护理，而干预后，这一比例平均为 17%。该团队在第二个指标上没有达到目标，即接受儿科护理的患病新生儿在产科病房的比例要低于 10%。
HUM 医院领导层做出了组建产科特别工作组的重要决定，以做出改变，这对该机构新母亲及其婴儿的生活产生了可持续的积极而持久的影响。实现了没有产后母亲和新生儿躺在地上的目标，并且由于我们的干预，在产科病房接受强化儿科护理的新生儿人数减少。
