633 - Introduction of a Designated Assessment and Resuscitation Team (DART) in regional, referral hospitals in Ghana to improve neonatal outcomes.

In Ghana, training in Helping Babies Breath and Essential Care for Every Baby at four regional hospitals (2013-2018) did not result in sustained improvements in neonatal care. Significant gaps remained due to shortages of personnel, frequent staff rotations, and limited continuing education resulting in poor quality newborn resuscitation and postdelivery care. Subsequently, NICU admission rates and mortality remained high. The Making Every Baby Count Initiative (MEBCI) 2.0 (2020-2024) is designed to strengthen newborn care at regional hospitals in Ghana through clinical training, quality improvement, and leadership engagement.

Objective:

A Designated Assessment and Resuscitation Team (DART) was conceptualized as a method to improve high quality and focused care to at-risk newborns during delivery, resuscitation, intra-hospital transport and postnatal evaluation.

Design/Methods:

The DART team consisted of midwifes, neonatal and pediatric nurses with experience in the labor ward, operating theatre and NICU. Interactive, didactic training sessions were conducted over one week, followed by hands-on clinical mentorship for an additional week.  Training included (a) Neonatal Resuscitation Program (AAP, 7^th edition); (b) transport of high-risk neonates; and (c) postnatal newborn evaluation. Monthly meetings were held virtually to review progress and barriers to improvement and implementation. A WhatsApp group was set up for regular communication and problem solving in each facility. Data were collected at one regional hospital to assess thoroughness of staff assignment and types of DART activities conducted per shift.

Results:

DART training was conducted in 2022 for two of four regional hospitals; 10-12 experienced providers were targeted per hospital. Data collected at Eastern Regional Hospital (December 12-31), found an average (range) of 2.5 (2-5) providers assigned to DART per 12-hour shift. Each shift, the DART attended 5.5 (5-10) high-risk deliveries, responded to 0.6 (0-3) calls for newborn evaluation, examined 23.6 (15-46) postnatal neonates, and transferred 1.7 (0-6) newborns to NICU.

Conclusion(s):

In the facilities where DART was introduced, leaders and administrators recognized the value of having a designated team for high-level newborn care. The initial experience demonstrates local buy-in and acceptance of DART as a way to address gaps in the care of at-risk newborns. Additional data are required to determine if DART will reduce neonatal mortality. There is potential that this concept can be applicable to improve newborn care in other low resource settings.