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Feasibility, Sustainability, and Effectiveness of the Implementation of “Facility-Team-Driven” Approach for Improving the Quality of Newborn Care in South India

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Indian Journal of Pediatrics Aims and scope Submit manuscript

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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Acknowledgements

The authors sincerely thank Delhi team who helped as facilitators to conduct first workshop on quality Improvement (Dr. Ashish Jain, Dr. Pratima Anand and Dr. Srikanth) and Team from St. John’s Medical College, Bangalore (Dr. Prasanth Y, Dr. Shashidhar T, Sister Sophia) who helped as facilitators to conduct second workshop (Preterm baby package) in Shivamogga. The authors thank the neonates and their parents for consenting for participation in the study and also the team at Shimoga Medical College for their support for the conduct of the current work. Also, they are thankful to Dr. Rajesh Mehta, Regional Adviser-Newborn, Child and Adolescent Health, World Health Organization (WHO)-Regional Office for South-East Asia for his critical inputs in the manuscript.

Team Shimoga Medical College: Manjunatha Swamy, Chandrashekar Malabennur, Shree Shail Benekanal, Vijayalaxmi, Sunitha P, Bhimaraya Shivasharana, Veeresh Santebennure Murigendarappa, Manoj Gendal Muddappagowda, Anjana Rao, Vikas Kagathur Gowdru, Chaitra Harishchandra, Akkamma Muttappa Attigeri, Shruthy Eshwar, Department of Pediatrics, Shimoga Medical College, Shivamogga, Karnataka, India

Funding

The study was funded through a grant by Queen Elizabeth Diamond Jubilee Trust (QEDJT) through Public Health Foundation of India (PHFI). The funding body had no role in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript.

Author information

Authors and Affiliations

  1. Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India

    S. Venugopal, Anu Thukral, Raja Ashok Koganti, M. Jeeva Sankar, Ramesh Agarwal & Ankit Verma

  2. Department of Pediatrics, Shimoga Medical College, Shivamogga, Karnataka, India

    Ravindra B. Patil, Vasanth Kumar DL, Manjunatha Swamy, Chandrashekar Malabennur, Shree Shail Benekanal, Vijaya Lakshmi, Sunitha P Cheluvaraj, Bhimaraya Shivasharana, Veeresh Santebennure Murigendarappa, Manoj Gendal Muddappagowda, Anjana Rao, Vikas Kagathur Gowdru, Chaitra Harishchandra, Akkamma Muttappa Attigeri & Shruthy Eshwar

  3. Himalayan Institute of Medical Sciences, Jolly Grant, Dehradun, Uttarakhand, India

    Ashok K. Deorari

Authors
  1. S. Venugopal
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Consortia

Team Shimoga Medical College

  • Manjunatha Swamy
  • , Chandrashekar Malabennur
  • , Shree Shail Benekanal
  • , Vijaya Lakshmi
  • , Sunitha P Cheluvaraj
  • , Bhimaraya Shivasharana
  • , Veeresh Santebennure Murigendarappa
  • , Manoj Gendal Muddappagowda
  • , Anjana Rao
  • , Vikas Kagathur Gowdru
  • , Chaitra Harishchandra
  • , Akkamma Muttappa Attigeri
  •  & Shruthy Eshwar

Contributions

VS: Principal investigator, reviewed literature, prepared the initial protocol and this manuscript, supervised data collection at Shimoga Medical College and performed analysis under supervision of MJS; RBP and VKDL: supervised data collection at Shimoga Medical College, helped guide teams through onsite mentoring and steered fortnightly team meeting and provided inputs and helped in finalization of this manuscript; RA, MJS, AT, AV, RAK: helped in preparation of initial protocol and this manuscript, supervised the study and critical revision of this manuscript; AKD: framed the idea and rationale of this study, reviewed the protocol, supervised this study throughout its course, critical revision and finalization of this manuscript; AT, RA and AKD: supervised the implementation, helped guide teams through remote mentoring. Team Shimoga Medical College was involved in quality improvement program training, formulating aim statements for QI projects, executing these projects, attending the bimonthly  QI meeting, and giving feedback. They collected data for the projects, analyzed data, and thereafter guided other teams for different QI projects. RBP will act as the guarantor for this paper.

Corresponding author

Correspondence to Ashok K. Deorari.

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Venugopal, S., Patil, R.B., Thukral, A. et al. 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 90, 974–981 (2023). https://doi.org/10.1007/s12098-023-04518-8

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