Creation of a unique centrally monitored and operated neonatal transport network in a lower and middle-income country: A first of its kind initiative

With the current growth of many neonatal units in the country, good initial stabilization of sick neonates is possible at peripheral centers. However, poor neonatal transport and retrieval facilities are unfortunately leading to higher preventable mortality and morbidity in neonates arriving at a tertiary care center in poor condition. To bridge the gap between referring hospital and tertiary care, this quality improvement initiative aimed to create a well-organized ‘network transport system’ for the round-the-clock provision of a city-wide retrieval system. Various causes linked to adverse events in the transport and retrieval of sick infants were initially assessed through a ‘fishbone analysis’. A step-wise-driven PDSA cycle was performed. It was realized that a well-organized, centrally controlled network of fully equipped neonatal ambulances with trained personnel for delivering neonatal intensive care on wheels was necessary even in a tier-one city like Bengaluru, India. A network transport and retrieval system for the city of Bengaluru was systematically created, involving 10 partner hospitals in the Manipal group. Training of all personnel involved in transport, creating a good infrastructure of state-of-the-art ambulances, transport incubators with ventilators, remote monitoring systems, and the creation of a centralized helpline with 24/7 response. The facility was named Neonatal Care on Wheels (NOW) and was propagated as a NICU on Wheels. This initiative significantly improved the quality of neonatal transport as well as the stabilization of the neonate before transport. This robust network transport has proven to show improvements in the quality of retrieval and survival similar to that seen in Western countries.