A Quality Improvement initiative to decrease Referral from a Subdistrict Hospital in Rural India

Background: Lack of knowledge and training of Health Care Providers (HCPs) in managing Pediatric Emergencies often lead to increased referral from Subdistrict hospitals, even without prior stabilization. Methods: A Quasi-experimental study done in a Subdistrict hospital in West Bengal, India, to identify the gaps in health care quality and safety as per National Quality Assurance Standards (NQAS). Training was arranged for HCPs and the effects on hospital referral rate was analyzed. 18 Emergency Medical Officers (EMOs) and 18 Emergency nurses were included in this study following convenience sampling. Multidisciplinary teams of 6 participants were trained every weekly, from January to June in 2024 on management of common pediatric emergencies. Results: Significant improvement was noted in confidence, knowledge and attitude of HCPs in managing common pediatric emergencies. There has been significant (15%) improvement in NQAS Hospital Score, p value <0.001, decrease in hospital referral rate (9.43% to 6.61%) and mortality rate (2.46% to 1.23%) from January to June 2024.