Objectives

To investigate the barriers and facilitators involved in the back-referral process of newborns from a tertiary care centre to district Special Newborn Care Units (SNCUs) for step-down care.

Methods

The study employed mixed methods, including feedback questionnaires for parents of back-referred neonates, in-depth interviews with doctors and nurses from six SNCUs, and focused group discussions with medical staff at a tertiary-level institute. The study was conducted over a period of seven and a half months in a north Indian tertiary care centre.

Results

The back-referral process received positive acceptance from parents and healthcare personnel. Notable barriers included the lack of Retinopathy of Prematurity (ROP) screening services in some SNCUs, inadequate free transport facilities for back-referral, and deficiencies in two-way communication. Parents provided valuable feedback for improvement, suggesting back-referral to the SNCU nearest to their home, daytime back-referral with adequate prior notice, and the availability of post-partum obstetric care at SNCUs for the mother. Inadequate environmental hygiene and limited availability of ROP services were identified as concerns. Facilitators included effective communication, proximity-based back-referral, and ongoing mentoring of SNCUs by tertiary centres.

Conclusions

Establishing efficient two-way communication between tertiary centres and district SNCUs, provision of essential facilities at SNCUs, and ensuring a seamless continuum of care are pivotal for successful back-referral of convalescent neonates. Addressing these factors can contribute to improving the back-referral process, level 3 bed availability at the tertiary centres and neonatal health outcomes.

中文翻译：

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恢复期新生儿的回诊：印度的挑战和策略

 目标

调查新生儿从三级护理中心回转至地区特殊新生儿护理单位 (SNCU) 进行降级护理的过程中涉及的障碍和促进因素。

 方法

该研究采用了混合方法，包括对回诊新生儿家长进行反馈问卷、对六个SNCU的医生和护士进行深度访谈以及与三级机构的医务人员进行集中小组讨论。该研究在印度北部的一个三级护理中心进行了七个半月。

 结果

回诊过程得到了家长和医护人员的积极认可。值得注意的障碍包括一些 SNCU 缺乏早产儿视网膜病变 (ROP) 筛查服务、用于回诊的免费交通设施不足以及双向沟通不足。家长提供了宝贵的改进反馈，建议回诊到离家最近的 SNCU、在事先充分通知的情况下在白天回诊，以及为母亲提供 SNCU 的产后产科护理。环境卫生不足和 ROP 服务的可用性有限被认为是令人担忧的问题。促进因素包括有效的沟通、基于邻近性的反向转介以及三级中心对 SNCU 的持续指导。

 结论

在三级中心和地区 SNCU 之间建立高效的双向沟通​​、在 SNCU 提供基本设施以及确保无缝连续护理对于成功回诊恢复期新生儿至关重要。解决这些因素有助于改善回诊流程、三级中心的 3 级床位可用性和新生儿健康结果。