Implementation of an in-patient pediatric mortality reduction intervention, Gondar University Hospital, Ethiopia.

SETTING

Gondar University Hospital (GUH) is a resource-limited tertiary care hospital in northern Ethiopia.

OBJECTIVE

To evaluate the aggregate effect of care standardization, institutional guidelines, and simulation-based training on pediatric mortality at a resource-limited hospital.

DESIGN

Uncontrolled pre-post study. GUH in-patients aged from 30 days to 14 years were included in the program evaluation (baseline 11 September-18 November 2010; intervention 19 September-9 December 2011). Interns attached to the GUH pediatrics department from 6 September to 9 December 2011 were included in the training evaluation. Institution-specific management guidelines were prepared for choking, respiratory distress, dehydration, sepsis, congestive heart failure, coma, and seizure. Approval for the protocols was obtained from each pediatric faculty member. Interns received a 3.5 h simulation-based training in triage, procedural skills, and protocol usage. Primary outcome was overall deaths (%); secondary outcomes were deaths within 24 h of admission (%) and median pre/post-training emergency management test scores (%).

RESULTS

No difference in mortality (OR 0.72, 95%CI 0.40-1.29, P = 0.265) or first 24 h mortality (crude OR 0.97, 95%CI 0.37-2.55) was observed. Trainee examination scores improved from 33% to 74% (P < 0.001).

CONCLUSION

Combining care standardization, management protocols, and simulation-based training did not reduce mortality among pediatric in-patients. Focused, simulation-based training improved short-term test scores among interns.