Outcome of the development of the care system for sick newborns at Mukdahan Hospital
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Abstract
Background: Sick newborns are highly vulnerable to early complications, and variations in care processes may contribute to preventable morbidity and prolonged hospitalization. Strengthening system-level neonatal care through structured quality improvement is essential to enhance clinical outcomes and sustainability.
Objective: To develop a structured care system for sick newborns at Mukdahan Hospital, evaluate its clinical and process outcomes, and assess nurses’ satisfaction following implementation.
Methods: A developmental research study using participatory action research (PAR) integrated with the CIPP evaluation framework and Donabedian’s Structure–Process–Outcome model was conducted from March 2025 to January 2026. The sample included 72 sick newborns (36 pre-intervention and 36 post-intervention) and 17 registered nurses. The intervention comprised a standardized clinical pathway and evidence-based care bundles. Data collection instruments included a neonatal clinical outcome record form, a clinical pathway compliance audit tool, and a nurse satisfaction questionnaire (Cronbach’s alpha =
0.89). Descriptive statistics were applied. Independent t-tests and Chi-square tests were used to compare pre- and post-intervention outcomes. Effect sizes and 95% confidence intervals (CI) were reported.
Results: After system implementation, the complication rate decreased from 26.7% to 10.0% (Risk Ratio 0.375; 95% CI 0.110–1.279). The mean length of hospital stay was reduced by 2.6 days (95% CI −4.00 to −1.20), with a large effect size (Cohen’s d = 0.96). Clinical pathway compliance improved from 62% to 91% (p < .001). Nurses reported very high satisfaction with the developed system (Mean 4.42 ± 0.38).
Conclusions: The development of a structured neonatal care system using PAR and systematic evaluation frameworks improved care processes and demonstrated clinically meaningful reductions in hospital stay and complications. This model may serve as a sustainable and scalable approach for neonatal quality improvement in similar healthcare settings.
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