Table 1:
Identified themes, sub-themes, and health indicators for assessment of hospitals’ perinatal services
| Theme | Sub-theme | Indicators |
|---|---|---|
| Input/structure | Health Human Resources | Number of staff (midwife, nurse) per delivery |
| Number of staff (midwife, nurse) per admission | ||
| 24-hour presence of a certified midwife for pregnancy assessment in the emergency department | ||
| Access to a pediatrician as needed (in ≤ 30 minutes) | ||
| Access to the gynecologist as needed (in ≤ 30 minutes) | ||
| Access to anesthesiologist as needed | ||
| Medical Staff Skillfulness | Basic nursing skills (venipuncture, oxygen therapy, etc.) | |
| Control of maternal bleeding | ||
| Diagnosis of high-risk pregnancy | ||
| Mothers’ education about pregnancy/neonatal care and red flags | ||
| Preparing the newborn for inter-hospital transfer | ||
| Neonatal resuscitation (applies for both gynecologist and anesthesiologist) | ||
| Teamwork | ||
| Physical Space | Independent midwifery admission unit in the emergency department | |
| Number of beds per delivery room area | ||
| Number of beds per postpartum care unit area | ||
| Special operating room for emergency cesarean section | ||
| Status of indoor access (elevator/standard stair) | ||
| Space heating and cooling | ||
| Room ventilation | ||
| Full-staff clinic for postpartum visits and follow-up | ||
| Full-staff clinic to visit and follow-up the newborns | ||
| Equipment | Basic equipment for pregnancy examination (sphygmomanometer, scales, fetal monitors) in the emergency room | |
| Natural childbirth facilities | ||
| Anesthesia facilities in the operating room | ||
| Primary oxygen therapy facilities (bag valve mask, pulse oximetry) for mother and newborn (4–6 hours after birth) | ||
| Neonatal resuscitation facilities | ||
| Phototherapy facilities | ||
| Technical Support and Information | HIS (hospital information system) | |
| Internet communication infrastructure to communicate with the guidance staff | ||
| File registration and maintenance system | ||
| Implementation of clinical care protocol | ||
| Implementation of referral protocol | ||
| Patient transfer form, containing the history of the neonatal clinical and paraclinical findings | ||
| Follow-up protocol for the healthy and non-healthy neonates | ||
| Checklists for periodic audits of the processes | ||
| Process | Medical Staff Retraining and Empowerment | Resuscitation workshop for the staff, pediatricians, gynecologists, and anesthesiologists |
| Basic nursing skills | ||
| Preparing the neonate for transfer | ||
| Providing experienced staff to accompany the patient when transferring | ||
| Educate mothers about pregnancy/neonatal care and red flags | ||
| Admission | Admission by a midwife | |
| Initial assessment of the mother in an independent midwifery unit in the emergency department | ||
| Considering the patient’s conditions and grading system | ||
| Patient Management | Educating the mother under pregnancy care on pregnancy red flags, expected delivery, and breastfeeding | |
| Simultaneous initiation of maternal care within the admission | ||
| Completing the partograph for delivery | ||
| Measuring the fetal heart rate during labor | ||
| Managing the pregnant women based on protocols during and after delivery | ||
| Initial examination of the newborn in the delivery room | ||
| Process | Referral | Completing the patient transfer form |
| Accompanying the patient with expert medical staff during inter-hospital transfers | ||
| Recording newborns’ information during the transfer | ||
| Recording newborns’ information upon delivery | ||
| Sending feedback on the transfer process and follow-up on the shortcomings of the transfer | ||
| Follow-up and Education | Determining and informing the patients about the follow-ups of the mother and the newborn at the time of discharge | |
| Follow-up on future visits of both mother and neonate | ||
| Educating mothers about breastfeeding | ||
| Performing regular screenings | ||
| Performing regular examinations of healthy infants based on the protocols | ||
| Monitoring and Regular Audit | Performing regular audits and process reviews | |
| Outcome | Mortality and Morbidity Indices | Number of maternal deaths per admissions |
| Number of LBW births per live births | ||
| VLBW number of births per live births | ||
| Number of infant deaths per number of live births (by gestational age) | ||
| Number of infant deaths per number of live births (by birth weight) | ||
| Number of infant deaths per number of live births (by cause) | ||
| Number of mothers in need of ICU per live birth | ||
| Number of discharges with personal consent per admission (mothers) | ||
| Number of neonatal nosocomial infections per neonatal admission | ||
| Number of sepsis cases per neonatal admission |