A leap forward in neonatal care
The RSPAD hospital's innovative approach to saving newborn lives
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Despite Indonesia’s notable 64.1 per cent reduction in neonatal mortality since 1990, the country still faces challenges, particularly in managing critically ill infants. With a neonatal mortality rate lower than 15 per 1,000 live births in 2021 – approximately 50,000 neonatal deaths1 – the nation is striving to ensure that around 230,000 critically ill newborns have access to special and intensive neonatal care to further reduce the number of neonatal deaths.
The Gatot Soebroto (RSPAD) Hospital, the national military and presidential hospital, has provided a leading example of implementing simple approaches to tackle this issue. In 2022, with UNICEF’s support and under the leadership of Lieutenant General TNI dr. Albertus Budi Sulistya, Sp.THT-KL(K), M.A.R.S Head of RSPAD Hospital, and Colonel Dr. dr. Rachmanto HSA, SpA, S.H, M.H Head of the Child Department, the hospital started to implement the Maternal and Perinatal Death Surveillance and Response (MPDSR) and Point of Care Quality Improvement (POCQI), which have led to marked improvements.
Dr. Windhi Kresnawati, an experienced pediatrician in neonatal health who brought her experience from successful UNICEF-supported neonatal care initiatives in Papua, led a team in the Neonatal Intensive Care Unit (NICU) to roll out the approaches. The NICU was inaugurated in 2020 with Major General TNI Dr. dr. Yenny Purnama, Sp. A (K), M.Kes, M.A.R.S, M.H as the Neonatologist in RSPAD who provide support to the initiatives.
Dr. Kresnawati’s concern and passion for ensuring every baby receives quality care motivated her to improve the services in RSPAD NICU. "Every preventable death of a baby is a call to action and a reminder to relentlessly improve our care," she says.
Through the MPDSR programme, the hospital assesses each neonatal death thoroughly to learn how to prevent future losses. "The MPDSR helped us determine whether a death was preventable and if so, how we could alter our procedures and administration to save lives," explains Dr. Kresnawati.
Learning from the MPDSR implementation, the NICU team managed to identify the main causes of neonatal deaths. To help prevent the occurrence of such deaths, Dr. Kresnawati guided the team to investigate further why newborns died due to the identified illnesses.
This led to the implementation of the POCQI approach, which empowers frontline healthcare workers to identify, analyze and address quality issues in real-time, ensuring immediate and effective responses to patient care challenges. This approach improves immediate care and fosters a culture of ongoing learning and adaptation. By implementing this approach, the team seeks to ensure that the NICU at RSPAD Hospital stays at the forefront of providing quality neonatal healthcare.
"The POCQI guided us in pinpointing issues and devising strategic solutions, significantly improving our care quality." she highlights.
The implementation of POCQI led to the development of quality improvement teams in the NICU, called “GENG CIHUY”, to address major issues in providing intensive neonatal care, including ventilation and airway support, emergency, resuscitation and patient safety, infection prevention and control, lactation and nutrition, parenteral and developmental care.
Dr. Kresnawati steers GENG CIHUY, which consists of five small teams, to implement strategies to improve the quality of intensive neonatal care, such as maintaining hand hygiene practices and optimizing care procedures. This simple approach has significantly reduced the incidence of hospital associated infections such as ventilator-associated infections.
"In the earlier death reviews, we identified the most common cause of neonatal deaths were preventable, nearly 7-10 cases monthly. Now, we're seeing a significant reduction, with most deaths due to congenital anomalies which were unpreventable deaths," she reflects.
“The MPDSR has not only structured our approach but also become a benchmark for hospital policy,” says Lieutenant General dr. Albertus Budi Sulistya, Sp.THT-KL(K), M.A.R.S. “The implementation of POCQI has been instrumental in improving our quality of care, which is crucial for patients under the National Health Insurance programme. We've seen a reduction in operational costs and patient spending as a result."
The impact of these initiatives extends beyond the clinical outcomes. It has helped the hospital to build a strong and dedicated team to deliver health services to the community. "The MPDSR and POCQI have fostered a sense of responsibility and togetherness among our staff. We've learned to collaboratively identify problems and solutions, focusing on support and resilience for both parents and infants," says Titi Ambar Asmarini, Head Nurse of the NICU.
Dr. Sulistya envisions extending the impact of these programmes beyond RSPAD. "Our goal is to create a contagious knock-on effect, influencing other hospitals to adopt MPDSR and POCQI. We're in communication with the Military Health Center to spread these practices across the Indonesian Army and Police hospitals."
The hospital's commitment to quality improvement, supported by continuous training and funding, ensures the long-term sustainability of these life-saving programmes. Their work is an important part of national efforts towards achieving target 3.2 of the Sustainable Development Goals, which is dedicated to eliminating deaths of newborns and children under five years of age.
The success story of RSPAD's NICU goes well beyond statistics, as the hospital sets an innovative example for the future of neonatal care in Indonesia.
1Improving maternal and newborn health and survival and reducing stillbirth: progress report 2023. Geneva: World Health Organization; 2023. Licence: CC BY-NC-SA 3.0 IGO
