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Elizalde J, Lumibao J, Lizarondo L. Barriers and facilitators to health professionals' engagement in quality improvement initiatives: a mixed-methods systematic review. Int J Qual Health Care 2024; 36:mzae041. [PMID: 38727534 DOI: 10.1093/intqhc/mzae041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 03/20/2024] [Accepted: 05/08/2024] [Indexed: 05/22/2024] Open
Abstract
Quality improvement (QI) initiatives in healthcare are crucial for enhancing service quality and healthcare outcomes. The success of these initiatives depends on the active engagement of healthcare professionals, which can be influenced by several factors within the healthcare system. This systematic review synthesized the factors influencing healthcare professionals' engagement in QI projects, focusing on identifying both barriers and facilitators. A mixed methods systematic review (MMSR) was conducted using the JBI methodology for MMSR. Databases such as MEDLINE, CINAHL, Scopus, and Embase were searched for studies that explored barriers and facilitators to QI engagement of health professionals in the clinical setting. Methodological quality was assessed using the Mixed-Methods Appraisal Tool (MMAT). The extracted data were synthesized using the JBI convergent integrated approach to MMSR. Eighteen studies (seven qualitative, nine quantitative, and two mixed-methods) published between 2007 and 2023 were included in the review. The analysis revealed barriers and facilitators to engagement in QI initiatives at different levels of the health system. At the QI program level, the engagement of health professionals to QI was influenced by the approach to QI, evidence underpinning the QI initiative, QI knowledge and training, and access to QI specialists. At the health professional level, barriers and facilitators were related to their organizational role, motivation, perceptions about QI, and collaborations with individuals and groups. At the organizational level, factors related to culture and climate, leadership, available resources (including human resource and workload, infrastructure, and incentives), and institutional priorities influenced health professionals' participation in QI. This review highlights the complex interplay of organizational, individual, and QI program level factors that influence the engagement of healthcare professionals in QI. Overcoming these complex barriers and leveraging facilitators is crucial for enhancing participation in QI efforts. The findings underscore the need for a multi-level strategy that focuses on creating a conducive organizational culture, providing robust leadership, and ensuring adequate resources and training for healthcare professionals. Such strategies hold the potential to enhance the effectiveness and sustainability of QI initiatives in healthcare settings.
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Affiliation(s)
- Joanna Elizalde
- College of Medicine, De La Salle University, Dasmariñas, Cavite 4114, Philippines
| | - Jommel Lumibao
- Quality Department, Qatar Red Crescent, Doha 202449, Qatar
| | - Lucylynn Lizarondo
- JBI, School of Public Health, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA 5005, Australia
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Adhisivam B. Quality Improvement Initiatives in Neonatal Care - The Way Forward. Indian J Pediatr 2023; 90:957-958. [PMID: 37548844 DOI: 10.1007/s12098-023-04805-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 07/19/2023] [Indexed: 08/08/2023]
Affiliation(s)
- Bethou Adhisivam
- Department of Neonatology, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India.
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Venugopal S, Patil RB, Thukral A, Koganti RA, Kumar Dl V, Sankar MJ, Agarwal R, Verma A, Deorari AK. Feasibility, Sustainability, and Effectiveness of the Implementation of "Facility-Team-Driven" Approach for Improving the Quality of Newborn Care in South India. Indian J Pediatr 2023; 90:974-981. [PMID: 37269503 DOI: 10.1007/s12098-023-04518-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 02/15/2023] [Indexed: 06/05/2023]
Abstract
OBJECTIVES The primary objective of the study was to assess the feasibility and sustainability of the implementation of the point of care quality improvement (POCQI) methodology for improving the quality of neonatal care at the level 2 special newborn care unit (SNCU). Additional objective was to evaluate the effectiveness of the quality improvement (QI) and preterm baby package training model. METHODS This study was conducted in a level-II SNCU. The study period was divided into baseline; intervention and sustenance phases. The primary outcome i.e., feasibility was defined as completion of training for 80% or more health care professionals (HCPs) through workshops, their attendance in subsequent review meetings and, successful accomplishment of at least two plan-do-study-act (PDSA) cycles in each project. RESULTS Of the total, 1217 neonates were enrolled during the 14 mo study period; 80 neonates in the baseline, 1019 in intervention and 118 in sustenance phases. Feasibility of training was achieved within a month of initiation of intervention phase; 22/24 (92%) nurses and 14/15 (93%) doctors attended the meetings. The outcomes of individual projects suggested an improvement in proportion of neonates being given exclusive breast milk on day 5 (22.8% to 78%); mean difference (95% CI) [55.2 (46.5 to 63.9)]. Neonates on any antibiotics declined, proportion of any enteral feeds on day one and duration of kangaroo mother care (KMC) increased. Proportion of neonates receiving intravenous fluids during phototherapy decreased. CONCLUSIONS The present study demonstrates the feasibility, sustainability, and effectiveness of a facility-team-driven QI approach augmented with capacity building and post-training supportive supervision.
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Affiliation(s)
- S Venugopal
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Ravindra B Patil
- Department of Pediatrics, Shimoga Medical College, Shivamogga, Karnataka, India
| | - Anu Thukral
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Raja Ashok Koganti
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Vasanth Kumar Dl
- Department of Pediatrics, Shimoga Medical College, Shivamogga, Karnataka, India
| | - M Jeeva Sankar
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Ramesh Agarwal
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Ankit Verma
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Ashok K Deorari
- Himalayan Institute of Medical Sciences, Jolly Grant, Dehradun, Uttarakhand, India.
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Frade Garcia A, Edwards EM, de Andrade Lopes JM, Tooke L, Assenga E, Ehret DEY, Hansen A. Neonatal Admission Temperature in Middle- and High-Income Countries. Pediatrics 2023; 152:e2023061607. [PMID: 37589082 DOI: 10.1542/peds.2023-061607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/02/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Despite being preventable, neonatal hypothermia remains common. We hypothesized that the proportion of newborns with hypothermia on admission would be high in all settings, higher in hospitals in middle-income countries (MIC) compared with high-income countries (HIC), and associated with morbidity and mortality. METHODS Using the Vermont Oxford Network database of newborns with birth weights 401 to 1500 g or 22 to 29 weeks' gestational age from 2018 to 2021, we analyzed maternal and infant characteristics, delivery room management, and outcomes by temperature within 1 hour of admission to the NICU in 12 MICs and 22 HICs. RESULTS Among 201 046 newborns, hypothermia was more common in MIC hospitals (64.0%) compared with HIC hospitals (28.6%). Lower birth weight, small for gestational age status, and prolonged resuscitation were perinatal risk factors for hypothermia. The mortality was doubled for hypothermic compared with euthermic newborns in MICs (24.7% and 15.4%) and HICs (12.7% and 7.6%) hospitals. After adjusting for confounders, the relative risk of death among hypothermic newborns compared with euthermic newborns was 1.21 (95% confidence interval 1.09-1.33) in MICs and 1.26 (95% confidence interval 1.21-1.31) in HICs. Every 1°C increase in admission temperature was associated with a 9% and 10% decrease in mortality risk in MICs and HICs, respectively. CONCLUSIONS In this large sample of newborns across MICs and HICs, hypothermia remains common and is strongly associated with mortality. The profound burden of hypothermia presents an opportunity for strategies to improve outcomes and achieve the neonatal 2030 Sustainable Development Goal.
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Affiliation(s)
- Alejandro Frade Garcia
- Boston Children's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Erika M Edwards
- Vermont Oxford Network, Burlington, Vermont
- Department of Pediatrics, Larner College of Medicine, Burlington, Vermont
- Department of Mathematics and Statistics, College of Engineering and Mathematical Sciences, The University of Vermont, Burlington, Vermont
| | | | - Lloyd Tooke
- Groote Schuur Hospital, University of Cape Town, South Africa
| | - Evelyne Assenga
- Muhimbili University of Health Sciences, Dar es Salaam, Tanzania
| | - Danielle E Y Ehret
- Vermont Oxford Network, Burlington, Vermont
- Department of Pediatrics, Larner College of Medicine, Burlington, Vermont
| | - Anne Hansen
- Boston Children's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
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Satija A, Lorenz KA, Spruijt O, Ganesh A, Singh N, Connell NB, Gamboa RC, Fereydooni S, Chandrashekaran S, Hennings T, Giannitrapani KF, Bhatnagar S. Quality Improvement in Itself Changes Your Thinking: Lessons From Disseminating Quality Improvement Methods Through a Multisite International Collaborative Palliative Care Project in India. JCO Glob Oncol 2022; 8:e2200147. [PMID: 36252162 PMCID: PMC9812511 DOI: 10.1200/go.22.00147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 08/12/2022] [Accepted: 09/01/2022] [Indexed: 01/06/2023] Open
Abstract
PURPOSE Seven major palliative care (PC) centers in India were mentored through the Palliative Care-Promoting Assessment and Improvement of the Cancer Experience (PC-PAICE) by US and Australian academic institutions to implement a quality improvement (QI) project to improve the accessibility and quality of PC at their respective centers. The objective was to evaluate the experiences of teams in implementing QI methods across diverse geographical settings in India. METHODS A quota sampling approach was used to elicit perspectives of local stakeholders at each site. The Consolidated Framework for Implementation Research informed development of a semistructured interview guide. Analysis leveraged deductive and inductive approaches. RESULTS We interviewed 44 participants (eight organizational leaders, 12 clinical leaders, and 24 team members) at seven sites and identified five themes. (1) Implementing QI methods enabled QI teams to think analytically to solve a complex problem and to identify resources. (2) Developing a problem statement by identifying specific gaps in patient care fostered team collaboration toward a common goal. (3) Making use of QI tools (eg, A3 process) systematically provided a new, straightforward QI toolkit and improved QI teams' conceptual understanding. (4) Enhancing stakeholder engagement allowed shared understanding of QI team members' roles and processes and shaped interventions tailored to the local context. (5) Designing less subjective processes for patient care such as assessment scales to identify patient's symptomatic needs positively changed work practices and culture. CONCLUSION Engaging and empowering multiple stakeholders to use QI methods facilitated the expansion and improvement of PC and cancer services in India. PC-PAICE demonstrated an efficient, effective way to apply QI methods in an international context. The impact of PC-PAICE is being magnified by developing a cadre of Indian QI leaders.
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Affiliation(s)
- Aanchal Satija
- Department of Onco-Anesthesia and Palliative Medicine, Dr B. R. Ambedkar, IRCH, AIIMS, New Delhi, India
| | - Karl A. Lorenz
- VA HSR&D Center for Innovation to Implementation (Ci2i), Menlo Park, CA
- Division of Primary Care and Population Health, Stanford University School of Medicine, Palo Alto, CA
| | - Odette Spruijt
- Peter MacCallum Cancer Center, University of Melbourne, Melbourne, VIC, Australia
| | - Archana Ganesh
- Department of Onco-Anesthesia and Palliative Medicine, Dr B. R. Ambedkar, IRCH, AIIMS, New Delhi, India
| | - Nainwant Singh
- VA HSR&D Center for Innovation to Implementation (Ci2i), Menlo Park, CA
- Division of Primary Care and Population Health, Stanford University School of Medicine, Palo Alto, CA
| | - Natalie B. Connell
- VA HSR&D Center for Innovation to Implementation (Ci2i), Menlo Park, CA
- Division of Primary Care and Population Health, Stanford University School of Medicine, Palo Alto, CA
| | - Raziel C. Gamboa
- VA HSR&D Center for Innovation to Implementation (Ci2i), Menlo Park, CA
- Division of Primary Care and Population Health, Stanford University School of Medicine, Palo Alto, CA
| | | | | | - Tayler Hennings
- VA HSR&D Center for Innovation to Implementation (Ci2i), Menlo Park, CA
| | - Karleen F. Giannitrapani
- VA HSR&D Center for Innovation to Implementation (Ci2i), Menlo Park, CA
- Division of Primary Care and Population Health, Stanford University School of Medicine, Palo Alto, CA
| | - Sushma Bhatnagar
- Department of Onco-Anesthesia and Palliative Medicine, Dr B. R. Ambedkar, IRCH, AIIMS, New Delhi, India
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Pulmonary Magnetic Resonance Imaging Replaces Bedside Imaging in Diagnosing Pneumonia in Infants. BIOMED RESEARCH INTERNATIONAL 2022; 2022:7232638. [PMID: 36164449 PMCID: PMC9509219 DOI: 10.1155/2022/7232638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/24/2022] [Accepted: 09/06/2022] [Indexed: 11/21/2022]
Abstract
Neonatal Bronchopulmonary Bedside Photography (NBBP) evaluates the consumption of lung magnetic resonance imaging as a replacement for bedside imaging in diagnosing infant pneumonia. In premature baby respiratory support, Neonatal Bronchopulmonary (NB) is one of the most dangerous consequences of accurate diagnosis that impact health alternatives once steroids are administered. Infants may experience eating issues and vomit if their condition is bad enough; lower birth weight, younger gestational age, and extensive breathing tube damage are the most frequently established risk factors as a component of a neonatal habitat. This paper introduces the Intelligent Medical Care (IMC) for Neonatal Bronchopulmonary Bedside Photography (NBBP), which enhances various preventive efforts such as prenatal steroid therapy. Because of many prenatal and postnatal variables, growth hormone and diet nutrients influence alveolar and vascular development. For the future prevention of NB, it is more likely that a combination of different therapies working on diverse causal pathways would be beneficial. This research in NBBP-IMC technology that enhances prenatal care medicines are the most excellent and effective treatments for all these neonates throughout the decades. As a result, premature babies at risk for NB may benefit from the findings of this research, which experts anticipate can inspire further studies in the area. The purpose of this paper is to emphasize the work performed to improve respiratory outcomes for babies at risk of NB and to place this work in perspective with relevant research currently being conducted simultaneously.
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Gopinath B, Kumar A, Sah R, Bhoi S, Jamshed N, Ekka M, Aggarwal P, Deorari A, Bhargava B, Kappagantu V. Strengthening emergency care systems to improve patient care for ST-elevation myocardial infarction (STEMI) at a high-volume tertiary care centre in India. BMJ Open Qual 2022; 11:bmjoq-2021-001764. [PMID: 35914815 PMCID: PMC9345032 DOI: 10.1136/bmjoq-2021-001764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 07/24/2022] [Indexed: 12/02/2022] Open
Abstract
Background ST-elevation myocardial infarction (STEMI) is a highly time-sensitive and life-threatening condition. Early recognition and timely management are challenging in a busy emergency department (ED), especially in low/middle-income countries where emergency systems are often fragmented. The aim of our quality improvement (QI) project was to increase the percentage of patients with STEMI undergoing primary percutaneous coronary intervention (PCI) with door to balloon (D2B) time of <90 min by 30% over 12 months. Methods As part of the first step in QI, baseline data were collected at different points in the process of care. Using process maps and fishbone analysis, delays in patient registration, ECG and communication with cardiology were identified as some bottlenecks, and change ideas were tested using plan–do–study–act cycles using point-of-care QI methodology. The majority of the change ideas focused on interventions in the ED like strengthening triage, training frontline staff, early diagnosis and quick transportation of patients. Results During the baseline phase, 22.22% of patients were found to have a D2B time of <90 min. We achieved an increase of 47.78% in patients receiving PCI within 90 min and hence increased to 70% at the end of the intervention phase. Data collected for 4 months after the intervention phase were found to have sustained the effort. Conclusion Significant improvement in the door to reperfusion time resulted from a meticulous assessment of emergency care processes by drawing process flow chart and implementation of change ideas like introduction of fast-track policy for patients with chest pain, reducing staff turnover in the triage area, formal training of staff, continuous engagement with cardiology team and by interchanging of processes which led to a reduction in time to ECG.
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Affiliation(s)
- Bharath Gopinath
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Akshay Kumar
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Sah
- Department of Emergency Medicine, BP Koirala Institute of Health Sciences, Dharan, Kathmandu, Nepal
| | - Sanjeev Bhoi
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Nayer Jamshed
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Meera Ekka
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Praveen Aggarwal
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Ashok Deorari
- Department of Paediatrics, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | | | - Vignan Kappagantu
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
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Mondal S, Banerjee M, Mandal S, Mallick A, Das N, Basu B, Ghosh R. An initiative to reduce medication errors in neonatal care unit of a tertiary care hospital, Kolkata, West Bengal: a quality improvement report. BMJ Open Qual 2022; 11:bmjoq-2021-001468. [PMID: 35545275 PMCID: PMC9092170 DOI: 10.1136/bmjoq-2021-001468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 03/12/2022] [Indexed: 11/22/2022] Open
Abstract
Background Medication errors are an emerging problem in various hospital settings, especially in neonates. A study conducted in the neonatal care unit of a tertiary institute in Kolkata as baseline over 3 months, revealed total error to be around 71.1/100 prescriptions (median medication error percentage: 63%). Purpose To assess the occurrences of medication errors and determine efficacy of Point-of-Care Quality improvement (POCQI) model in reducing the same from baseline 63% to less than 10%, in the above setting within next 9 months. Materials and methods This quality improvement initiative of quasi-experimental design comprised randomly selected prescriptions and monitoring sheets of neonates admitted in the neonatal care unit, obeying inclusion and exclusion criteria. Medication errors were assessed and categorised using a predesigned and pretested checklist. Interventions were planned after forming a quality improvement team in four plan–do–study–act (PDSA) cycles spanning over 6 weeks each (including training of doctors and nurses, signature and countersignatures of respective healthcare personnel, computer-generated prescriptions and newly designed software-generated prescriptions) as per POCQI model of the WHO and results in post-intervention phase (3 months) were compared. Results A total of 552 prescriptions and monitoring sheets of 124 neonates were studied. Median medication error percentages in first, second, third and fourth PDSA cycle were, respectively, 48%, 42%, 30% and 14%. Total error reduced to 10.4/100 prescriptions (p<0.005), with significant reduction in erred dosage, timing, interval, preparation and rate of infusion of drugs in prescriptions of the post-intervention phase. Conclusion Implementation of change ideas via PDSA cycles, as per the POCQI model with technological aid, significantly decreased the percentage of medication errors in neonates, which was also sustained in the post-intervention phase and facilitated error-free prescriptions.
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Affiliation(s)
- Sayantan Mondal
- Pediatrics, Murshidabad Medical College and Hospital, Murshidabad, West Bengal, India
| | - Mukut Banerjee
- Pediatrics, Nilratan Sircar Medical College and Hospital, Kolkata, West Bengal, India.,Pediatrics, Burdwan Medical College and Hospital, Burdwan, West Bengal, India
| | - Shrabani Mandal
- Pediatrics, Nilratan Sircar Medical College and Hospital, Kolkata, West Bengal, India
| | - Asim Mallick
- Pediatrics, Nilratan Sircar Medical College and Hospital, Kolkata, West Bengal, India
| | - Nina Das
- Pharmacology, KPC Medical College and Hospital, Jadavpur, West Bengal, India
| | - Biswanath Basu
- Pediatrics, Nilratan Sircar Medical College and Hospital, Kolkata, West Bengal, India
| | - Ritu Ghosh
- Community Medicine, Murshidabad Medical College and Hospital, Murshidabad, West Bengal, India
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Dolma Y, Rajput A, Joji A, Chandra P. Improving surgical scrub time in the eye operation theatre using quality improvement methodology. Indian J Ophthalmol 2021; 69:1972-1973. [PMID: 34146079 PMCID: PMC8374773 DOI: 10.4103/ijo.ijo_1006_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Yangchen Dolma
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Asha Rajput
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Anie Joji
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Parijat Chandra
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Thukral A. Quality Improvement: "The Way Forward". Indian J Pediatr 2021; 88:3-4. [PMID: 33037994 DOI: 10.1007/s12098-020-03527-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 10/05/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Anu Thukral
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.
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The impact of a quality improvement project to reduce admission hypothermia on mortality and morbidity in very low birth weight infants. Eur J Pediatr 2020; 179:1851-1858. [PMID: 32506219 DOI: 10.1007/s00431-020-03711-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/27/2020] [Accepted: 05/29/2020] [Indexed: 10/24/2022]
Abstract
This prospective observational study was aimed to analyze the impact of a quality improvement project to reduce admission hypothermia on composite outcome of neonatal mortality and major morbidities. Infants with birth weight between 500 and 1499 g and gestation ≥ 25 weeks without major congenital malformations delivered between January 2018 and January 2020 who were admitted directly from delivery room to NICU were included in the study. Study period was divided in three phases including pre-intervention, intervention and post-intervention phase. There were a total of 368 VLBW infants included in the study. Mean admission temperature of neonates was 35.3 ± 0.6 °C, 36.0 ± 0.8 °C, and 36.4 ± 0.4 °C during pre-intervention, intervention, and post-intervention phase, respectively. Absolute incidence of composite outcome was 31%, 20%, and 13.2% during pre-intervention, intervention, and post-intervention phase, respectively. Risk of adverse composite outcome was significantly lower in post-intervention period as compared to pre-intervention period (aRR 0.68, 95% CI 0.49-0.92). Nosocomial sepsis and need for invasive ventilation was also significantly less in post-intervention period as compared to pre-intervention period.Conclusion: Implementation of thermoregulatory interventions best suited to local settings help in significant reduction of neonatal hypothermia, which in turn can help to improve neonatal outcomes. What is known: • Admission hypothermia is associated with adverse neonatal outcomes. • Implementation of quality improvement projects help reducing hypothermia incidence. What is new: • Implementation of quality improvement project to reduce admission hypothermia resulted in reduction in incidence of adverse composite neonatal outcome. • Also implementation of quality improvement project led to reduction in incidence of nosocomial sepsis and need of invasive ventilation.
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Patodia J, Mittal J, Sharma V, Verma M, Rathi M, Kumar N, Jain R, Goyal A. Reducing admission hypothermia in newborns at a tertiary care NICU of northern India: A quality improvement study. J Neonatal Perinatal Med 2020; 14:277-286. [PMID: 33044201 DOI: 10.3233/npm-190385] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Hypothermia at admission to neonatal intensive care units (NICU) is associated with increased morbidity and mortality in newborns. A baseline study at a tertiary care hospital with all out-born babies showed admission hypothermia of 82%. OBJECTIVE To reduce admission hypothermia (moderate) in newborns at least by 50% in next 6 months. METHODS A quality improvement (QI) study was planned using WHO Point of Care Quality Improvement Model (POCQI), [17] using PDSA (Plan-Do-Study-Act) cycle approach from April 2018 to March 2019, and including 427 term and preterm babies. We educated the staff, reinforced the use of caps, cling wraps, warm linen, introduced Ziploc bags and ensured adequate use of transport incubator. RESULTS After 6 months, overall admission hypothermia decreased from 82% to 45%, moderate hypothermia reduced from 46% to <10% (P < 0.001) and severe hypothermia (3%) was completely eliminated. There was also significant reduction in incidence of Intraventricular hemorrhage (13% Vs 4.7%), Late onset neonatal sepsis (38% Vs 19%) and metabolic acidosis (43% Vs 28%). We were able to sustain this improvement for the next 6 months and is ongoing. The strongest predictor of hypothermia was newborns being in the phase before QI initiative was started (OR 2.36, 95% CI 1.47, 3.23). CONCLUSION This study is a cost effective approach in reducing admission hypothermia in NICU in a resource limited setting with all outborn babies, and further decreasing the morbidity associated with it. Hence, emphasizing the importance of maintaining euthermia, not only in delivery rooms, but also during transportation.
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Affiliation(s)
- J Patodia
- Department of Neonatology, Neoclinic Children Hospital, Jaipur, Rajasthan, India
| | - J Mittal
- Department of Neonatology, Neoclinic Children Hospital, Jaipur, Rajasthan, India
| | - V Sharma
- Department of Neonatology, Neoclinic Children Hospital, Jaipur, Rajasthan, India
| | - M Verma
- Department of Neonatology, Neoclinic Children Hospital, Jaipur, Rajasthan, India
| | - M Rathi
- Department of Neonatology, Neoclinic Children Hospital, Jaipur, Rajasthan, India
| | - N Kumar
- Department of Neonatology, Neoclinic Children Hospital, Jaipur, Rajasthan, India
| | - R Jain
- Department of Neonatology, Neoclinic Children Hospital, Jaipur, Rajasthan, India
| | - A Goyal
- Department of Neonatology, Neoclinic Children Hospital, Jaipur, Rajasthan, India
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Sharma D, Murki S, Pratap T, Deshbotla SK, Vardhelli V, Pawale D, Kulkarni D, Arun S, Bashir T, Anne RP. Association between admission temperature and mortality and major morbidity in very low birth weight neonates - single center prospective observational study. J Matern Fetal Neonatal Med 2020; 35:3096-3104. [PMID: 32838635 DOI: 10.1080/14767058.2020.1810229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND OBJECTIVE Hypothermia is a common problem especially in preterm neonates and has been associated with increased neonatal mortality and morbidities. The objective of our study was to look into the distribution of admission temperature among VLBW neonates getting admitted to the NICU, association of admission temperatures to selected neonatal morbidities/mortality, and to evaluate for modifiable factors contributing to hypothermia. METHODS Infants with birth weight between 500 and 1499 g and gestation ≥ 25 weeks without major congenital malformations delivered between October 2017 and March 2020 who were admitted directly from the delivery room to the NICU were included in the study. Data were collected prospectively on perinatal/birth characteristics to look for their association with admission hypothermia, and to look into the association of admission temperature with selected neonatal morbidities/mortality. RESULTS There were a total of 538 neonates with the mean birth weight of 1206 ± 271 g included in the study. Mean admission temperature was 35.8 ± 1.3 °C. Low delivery room temperature was the most important contributor to admission hypothermia. Also, 3.3% of neonates were hyperthermic at admission to NICU, all of them having been delivered to mothers with intrapartum pyrexia. On adjusted analysis, we found that low admission temperature significantly increased therisk of adverse composite neonatal outcomes with admission temperature < 34.5 °C having 42% increased risk of the adverse outcome when compared to normothermic neonates. CONCLUSION Admission hypothermia remains a common problem in preterm neonates which is significantly associated with adverse neonatal outcome.
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Affiliation(s)
- Deepak Sharma
- Department of Neonatology, Fernandez Hospital, Hyderabad, India
| | - Srinivas Murki
- Department of Neonatology, Fernandez Hospital, Hyderabad, India
| | - Tejo Pratap
- Department of Neonatology, Fernandez Hospital, Hyderabad, India
| | | | | | - Dinesh Pawale
- Department of Neonatology, Fernandez Hospital, Hyderabad, India
| | | | - Subash Arun
- Department of Neonatology, Fernandez Hospital, Hyderabad, India
| | - Tanveer Bashir
- Department of Neonatology, Fernandez Hospital, Hyderabad, India
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Quality Care: Need of the Hour. Indian Pediatr 2020. [DOI: 10.1007/s13312-020-1747-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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