Development of a Network Service System for the Same Delivery Room Model to Avoid Maternal Mortality from Preventable Causes, Surin Province

Abstract

Objectives of this research were to 1) evaluate the development of a network service system for the same delivery room in management, operational process, products, outcomes, and impacts aspects and 2) examine factors affecting the success of the development of the same delivery room network service system to provide recommendations for actions to reduce maternal mortality. Samples were drawn using purposive sampling technique and included 6 obstetricians, 46 operating room nurses, 34 MCH board members, and 140 pregnant women who delivered in all hospitals in Surin province in 2020. The data were collected using focus group discussions, a questionnaire that assessed knowledge and skills in using delivery records, workshops, and related document reviews. Statistics used quantitative data analyses were frequencies, percentages, means and standard deviations. Qualitative data were analyzed using content analyses and triangulations. The development of the network service system for the same delivery room can be categorized into 4 aspects: 1) Management: MCH boards were appointed at both provincial and district levels. Situations and problems were analyzed at all levels. 2) Process: plans for the same delivery room model to reduce maternal mortality from preventable causes were developed with a clear directive line among network hospitals. Trainings for hospitals personnel to provide care for women with obstetrics emergency were conducted. The network communicated and consulted using Tele-Line consulting system (TCS). Meetings and knowledge management were used to develop the quality service network for one province one labor room. Guidelines for coordination and referral among service zones were developed to reduce maternal mortality to 0. 3) Products and outcomes: MCH board meetings at provincial level were held 3 times a year while meetings

at the regional level were held 2 times a year. At the hospital level, maternal mortality conferences were conducted monthly while perinatal conference were conducted every 3 months. Empowerment visits (coaching) at hospitals within 5 network zones. Obstetricians from Surin hospital provided consultation for node hospitals through TCS. Fast-track system was also set up. Assessment results showed that the node hospitals passed the quality criteria for quality delivery rooms. Knowledge assessment results from the hospital staff trainings was at a high level. Hospital staffs’ overall satisfaction on the one labor room system to prevent maternal mortality was at a high level. 4) Impacts: maternal mortality ratios of Surin province during 2017 and 2020 was 0, 9.04, 28.73 and 19.82, respectively. All maternal deaths were from Indirect causes. Factors contributed to the success were that administrators from all levels viewing maternal mortality as an important issue, clear policies, budget supports, problem solving by multidisciplinary both within and among hospital networks, and continuing knowledge and experience sharing. It is recommended from this study for administrators at all levels to provide continuing supports in service management and implementation, develop hospital staffs and related personnel to their full potential, create participations in all sectors, develop a consultation system between general physicians and obstetricians and obstetrician and internist for effective case management through Line chat/line groups.