Improving the care of term babies at risk of hypoglycaemia: A microsystem approach.

AIM: Neonatal hypoglycaemia is a common problem, often requiring admission to the neonatal intensive care unit (NICU). Our aim was to reduce term admissions to NICU for hypoglycaemia by 50% over 4 years. METHODS: Inborn term babies from 1 January 2015 to 31 December 2018 were included. Using quality-improvement methodology, we designed interventions based on human factors to incorporate best practice recommendations for babies at-risk of hypoglycaemia. This included standardisation of local guidelines, introduction of educational programmes to reiterate changes to practice and a multidisciplinary steering group to review term admissions to better understand the cause of failure of the maternal-neonatal pathway. The outcome measures were the number of term babies admitted to NICU for hypoglycaemia and the proportion of these babies not requiring intravenous (IV) dextrose. Run charts were used to monitor hypoglycaemia admissions and the impact of each intervention. RESULTS: There was an overall reduction in the number of term babies admitted to NICU for hypoglycaemia from 36 babies in 2014 (baseline) to 5 babies in 2018. The percentage of babies admitted to the neonatal unit who did not require IV dextrose decreased from 22/36 (61%) in 2014 to 0/5 (0%) in 2018. Admissions from the delivery suite decreased from 21/36 (58%) to 1/5 (20%). There were no adverse outcomes observed in the period before or after the intervention. CONCLUSIONS: We demonstrate a simple, cost-effective quality improvement project using fundamental human factors principles. This initiative successfully reduced the number of term admissions for hypoglycaemia over 4 years.

General practitioner's (GP) home management guidelines for COVID-19 patients: Guidelines.

Carefully developed guidelines for clinical practice serve as an important tool for desirable changes in health care of a country. They act as an important source of information for physicians as well as policy makers and educational institutions thereby improving the quality of care of patients. The outbreak of Novel Coronavirus Disease (COVID-19) in 2019 has placed a huge burden on health care system globally. The first line health care provider bears the brunt of this disease with limited and varying sources of information as most of the patients present to them. Varied presentation of disease along with limited hospital facilities for admission is a huge challenge for appropriate management and referral of these patients. These guidelines, prepared after reviewing the interim guidelines in literature, will serve as a source of guidance for GPs to manage mild cases at home and refer those with moderate and severe disease to tertiary care hospitals.