Evaluation of Maternal & Newborn Health Simulation Lab Centers of Excellence in Seven Referral Hospitals of Nepal

Post-partum hemorrhage (PPH) and birth asphyxia are significant contributor to maternal and neonatal mortalities globally. Postpartum hemorrhage leads to around 70,000 deaths, mostly in low and middle-income countries. Despite evidence indicating that active management of the third stage of labor (AMTSL) can mitigate PPH occurrence by 40-70%, adherence to this practice remains limited according to guidelines. Similarly, birth asphyxia accounts for an estimated 900,000 deaths each year and is one of the primary causes of early neonatal mortality. Addressing these critical issue requires multiple approach including the competency of health care providers. In order to optimally utilize the knowledge and skills learnt by the students and health care service providers, it is important to create opportunities for reorientation not only with regard to knowledge but also to reinforce skills. Creating simulation based skills lab for pre-service and in-service with linkages for post training mentorship is a step in this direction. Comprehensive simulation lab with skills stations are designed with the aim of acquisition and upgradation of skills of healthcare providers to enhance their capacity in providing quality maternal and neonatal health care. A simulation skills laboratory has the advantage that allows learners opportunities for repetition and feedback and permits individualized learning. Globally, simulation based intervention studies report evidence of impact of patient level outcomes including, reduction is maternal complication such as PPH and retained placenta; as well as neonatal outcomes such as birth asphyxia, stillbirth, and newborn deaths. Simulation lab provides a safe and controlled environment for healthcare providers to practice and refine their skills particularly in managing obstetric emergencies such as post-partum hemorrhage and birth asphyxia. Therefore, this study will help to bridge the gap in healthcare provider's skills and improve patient safety in maternal and neonatal healthcare by establishing high fidelity simulation labs in seven strategically located referral hospitals. The hospital staff will also benefit from training available within the simulation labs. The current study will assess the effect of establishing high-fidelity simulation labs on both implementation and patient outcomes in the hospitals. In this study the patient-level assessments include assessment of the proportion of PPH, rate of blood transfusions after PPH, and proportion of newborns with APGAR score less than 7 at 5 minutes' assessment. Our study will use the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework for the evaluation as it focuses on the issues, dimensions, and steps in program design, dissemination, and implementation process, which has been translated and used in different contexts and settings.

Research Method:

Concurrent nested mixed- method study to evaluate each component of RE-AIM using a quasi-experimental pre and post-test design.

Study sites:

The study sites will be the seven referral hospitals from five different Provinces of Nepal- Paropakar Maternity and Women's Hospital (Bagmati Province), Provincial Hospital Janakpur (Madhesh Province), Koshi Hospital (Koshi Province), Narayani Hospital (Madhesh Province), Province Hospital Surkhet (Karnali Province), BPKIHS (Koshi Province), and Pokhara Academy of Health Sciences (Gandaki Province) with annual deliveries of 24344; 8058; 8065; 7118; 5239; 3620; and 8915 respectively. Overall, these sites have a total of 65,359 deliveries in a year (Source HMIS data (2078/79))