1. Early Initiation of Emergency Management of Sick Neonate
Point of Care Quality Improvement
WHO Collaborating Center for Training and Research in Newborn Care
Early Initiation of Emergency Management of Sick Neonate
Prof. Dr. Asim Kumar
MallickIn-charge Neonatal Unit,
NRS Medical College and HospitalKolkata,
West Bengal, India

2. Background Context & Problem Statement
Initiation of emergency treatment of sick new born within 30 minutes will reduces mortality and provide timely treatment . Early treatment will reduce complications ( like organ damage ) thus reduces hospital stay of neonate. It also reduces morbidity and long term sequale in neonate. It reduces the financial burden of the family and as a whole cost of therapy.

3. In a prospective cohort study of 91 infants and children presenting to community hospitals with septic shock (defined by hypotension or delayed capillary refill), each hour delay in initiation of appropriate resuscitation or persistence of hemodynamic abnormalities was associated with a clinically significant increased risk of death (odds ratio [OR] 1.5 and 2.3, respectively)**
**Han YY, Carcillo JA, Dragotta MA, et al. Early reversal of pediatric-neonatal septic shock by community physicians is associated with improved outcome. Pediatrics 2003; 112:793.

4. Problems Delay in receiving the sick neonate in triage by Sisters.
No Dedicated person posted in triage.
Delay in processing of admission ticket.
No Separate Emergency tray in triage hence delay.

5. Run Charts on base line data
Senior Residents (who is assigned) measure the time by using stop clock and record.

6. Aim Statement
To initiate emergency management of all Sick Newborn admitted in our SNCU before 30 minutes (from two hours now) within 8 weeks from current of 20% to 80 % (within 30/04/2017)

7. Team Members Dr. Asim Kumar Mallick (Leader )
Dr. Biswajit Mondal (Analyser)
Dr. Gopal Pandey (Time Keeper)
Dr. Mahammad Kalam (Communicator)
Bina Acharya(Sister In-charge)
Archana Ghosh(Staff Nurse)
Sunipa Pramanik(Staff Nurse)
Samaresh Kar (DEO)

8. Process flow ** Intervention Point Register at Triage
Neonate Received at SNCU
Register at Triage
Baby Placed in Radiant Warmer
Asking the Doctor for Examination of the Baby
Examination done by the Doctor
Emergency Signs Present
Discharge with advice
Advice given by the Doctor
Emergency Treatment given
Baby Stable
Admission in SNCU
Yes NO
**20 Min
5 Min
2 Min
**20 Min (Variable)
** Intervention Point

9. Fish Bone Analysis

10. Driver Diagram

11. Change Idea(s) & PDSAs
1)Posting or assigning responsibility in each shift of Doctors and Nurses in SNCU triage.
2) Immediate receiving of sick neonate at triage by the nurses.
3) Separate emergency tray in triage.
4) Use of Stopwatch for measuring time.
5) Use of Sticker

12. Measurements
Outcome- Proportion of babies receiving emergency management within 30 minutes
Process: 1)Percentage of receiving baby immediately by nurses
2) Percentage of time of Posting of dedicated Sisters and Doctors in triage.
3) Percentage of Doctors and nurses following the emergency protocol.
Balancing Measures: Over crowding at triage area.

13. PDSA –I assigning responsibility in each shift of Doctors and Nurses
Assigned Doctor
Assigned Nurse
Time Keeper
Team

14. PDSA-I
Triage Sticker

15. PDSA-II Separate emergency tray in triage.
Doctor and Nurse checking the List at each shift

16. CHECK LIST

17. PDSA-III
Training of Doctors and Nurses for protocol treatment plan for Sick New Born.
Emergency cases –
Hypothermia (temp < 360C)
-Apnea or gasping respiration
-Severe respiratory distress (rate>70, severe retractions, grunt)
-Central cyanosis
-Shock (cold periphery, CFT>3secs, weak& fast pulse)
-Coma, convulsions or encephalopathy

18. Run Chart in Morning Shift
BASE LINE DATA
PDSA -1
BASE LINE MEDIAN
EXPECTED MEDIAN
PDSA -2
PDSA -3

19. Run Chart in Evening Shift
BASE LINE MEDIAN
EXPECTED MEDIAN
BASE LINE DATA

20. Run Chart in Night Shift
BASE LINE MEDIAN
EXPECTED MEDIAN

21. Comparative Run Chart(Morning, Evening and Night)

22. Our observations….
Looking at benefits of Triaging in morning shift and sharing the data with other shift nurses/doctors despite heavy rush in evening
On duty Doctors and Nurses of Evening and night shift are inspired by seeing the morning shift staff success.
Implement these change ideas to other shifts (Evening & Night) soon by sharing the success story among other health professionals and leadership of Hospital.

23. Thank You