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

Objective: To determine efficacy of Point-of-care Qualityimprovement (POCQI) in early initiation (within 30 minutes) ofemergency treatment among sick neonates.Design: Quality improvement project over a period of twentyweeks.Setting: Special Newborn Care Unit (SNCU) of a tertiary carecenter 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 sicknewborns. After baseline phase of one month, a qualityimprovement (QI) team was formed and conducted three PDSAcycles (PDSA I , PDSA II and PDSA III) of 10 d each, followedby a post-intervention phase over 3 months.Main outcome measure(s): Percentage of sick babies gettingearly emergency management at SNCU triage.Results: 309 neonates were enrolled in the study (56 inbaseline phase, 88 in implementation phase and 212 in post-intervention phase). Demographic characteristics includingbirthweight and gestational age were comparable amongbaseline and post intervention cohorts. During implementationphase, successful early initiation of management was notedamong 47%, 69% and 80% neonates following PDSA I, PDSA IIand PDSA III, respectively. In comparison to baseline phase, thepercentage of neonates receiving treatment within 30 minutesof arrival at triage increased from 20% to 76% (P<0.001) andthe mean (SD) time of initiation of treatment decreased from80.8 (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 alsosignificantly lower among post intervention cohort in comparisonto baseline cohort.Conclusion: Stepwise implementation of PDSA cyclessignificantly increased the percentage of sick newborns receivingearly emergency management at the SNCU triage, therebyresulting in better survival.

Hemophilia a and congenital Hypofibrinogenemia: A rare association in same family.

Hemophilia A is the commonest inherited coagulation defect in human beings, whereas congenital hypofibrinogenemia is a much rarer disease. Occurrence of these two inherited diseases in the same family has not been reported so far. Younger sibling of a known case of Hemophilia A presented with recurrent, spontaneously occurring echymotic spots having prolonged PT, APTT, TT and very low absolute fibrinogen level with normal factor VIII level ultimately diagnosed as a case of congenital hypofibrinogenemia.