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Acta Paediatr. 2017 Oct;106(10):1666-1673. doi: 10.1111/apa.13940. Epub 2017 Jul 14.

Using quality improvement to decrease birth asphyxia rates after 'Helping Babies Breathe' training in Kenya.

Author information

1
Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
2
Tenwek Hospital and Tenwek School of Nursing, Bomet, Kenya.
3
Global Child Health Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
4
Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
5
James Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.

Abstract

AIM:

The Helping Babies Breathe (HBB) programme is known to decrease neonatal mortality in low-resource settings but gaps in care still exist. This study describes the use of quality improvement to sustain gains in birth asphyxia-related mortality after HBB.

METHODS:

Tenwek Hospital, a rural referral hospital in Kenya, identified high rates of birth asphyxia (BA). They developed a goal to decrease the suspected hypoxic-ischaemic encephalopathy (SHIE) rate by 50% within six months after HBB. Rapid cycles of change were used to test interventions including training, retention and engagement for staff/trainees and improved data collection. Run charts followed the rate over time, and chi-square analysis was used.

RESULTS:

Ninety-six providers received HBB from September to November 2014. Over 4000 delivery records were reviewed. Ten months of baseline data showed a median SHIE rate of 14.7/1000 live births (LB) with wide variability. Ten months post-HBB, the SHIE rate decreased by 53% to 7.1/1000 LB (p = 0.01). SHIE rates increased after initial decline; investigation determined that half the trained midwives had been transferred. Presenting data to administration resulted in staff retention. Rates have after remained above goal with narrowing control limits.

CONCLUSION:

Focused quality improvement can sustain and advance gains in neonatal outcomes post-HBB training.

KEYWORDS:

Hospital practices; Neonatal resuscitation; Quality improvement; Simulation; Sub-Saharan Africa

PMID:
28580692
DOI:
10.1111/apa.13940
[Indexed for MEDLINE]

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