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.

Omental cyst masquerading as ascites.

Two children presented with massive generalised enlargement of abdomen simulating ascites. Common medical causes being excluded. They were treated with antituberculous drugs without any response until the radiological features suggested and surgical exploration proved the condition to be omental cyst.