Use of WHO quality assessment/quality improvement tool for maternal and newborn care for gap analysis and POCQI methodology to improve preterm neonatal outcomes at a tertiary care centre: a quality improvement initiative.

Abstract

Preterm birth is a leading cause of neonatal mortality and morbidity globally. Evidence suggests that over three-quarters of premature deaths can be prevented through cost-effective interventions. However, compliance with evidence-based guidelines in neonatal care often falls <50%, even in well-resourced settings. The study evaluated system gaps using WHO Quality Assessment/Quality Improvement Tool for Maternal and Newborn Care (WHO QA/QI MN) and implemented Point of Care Quality Improvement (POCQI) methodology to improve and sustain the composite outcome of mortality and/or major morbidities, including bronchopulmonary dysplasia, necrotising enterocolitis stage 3, late-onset sepsis and intraventricular haemorrhage grade ≥3. The study was conducted over 14 months. The adapted WHO QA/QI MN tool and POCQI methodology were used to focus on key clinical practices, namely, kangaroo mother care (KMC), use of mother's own milk (MoM) and antibiotic usage, utilising multiple plan-do-study-act cycles. Among 961 preterm neonates enrolled, KMC rates increased from 70.25% to 85.58%, and exclusive MoM use by day 7 increased from 59.24% to 70.2%. Antibiotic use declined from 25.5% to 20.67%. While process improvements were noted, the composite outcome of mortality and major morbidities did not show statistically significant reduction; however, a decreasing trend was observed post-intervention. This study demonstrates the feasibility of using the WHO tool by trained personnel for gap analysis. POCQI is an important approach to enhance evidence-based care practices and sustain good outcomes for preterm neonates in resource-limited settings. A longer follow-up may be needed to observe significant improvements in clinical outcomes.