This research is made possible through the generous support of Exciton Technologies Inc.

BACKGROUND AND OBJECTIVES: Significant variation in management of febrile infants exists both nationally and within our institution. Risk stratification can be used to identify low-risk infants who can be managed as outpatients without lumbar puncture (LP) or antibiotics. Our objective was to reduce invasive interventions for febrile infants aged 29 to 60 days at low risk for serious bacterial infection (SBI) through implementation of a clinical pathway supported by quality improvement (QI). METHODS: The evidence-based clinical pathway was developed and implemented by a multidisciplinary team with continuous-process QI to sustain use. Low-risk infants who underwent LP, received antibiotics, and were admitted to the hospital were compared pre-and postpathway implementation with SBI in low-risk infants and appropriate care for highrisk infants as balancing measures. RESULTS: Of 350 included patients, 220 were pre-and 130 were postpathway implementation. With pathway implementation in July 2016, invasive interventions decreased significantly in low-risk infants, with LPs decreasing from 32% to 0%, antibiotic administration from 30% to 1%, and hospital admission from 17% to 2%. Postimplementation, there were 0 SBIs in lowrisk infants versus 29.2% in high-risk infants. The percentage of high-risk patients receiving care per pathway remained unchanged. Improvement was sustained for 12 months through QI interventions, including order-set development and e-mail reminders. CONCLUSIONS: Implementation of a clinical pathway by using QI methods resulted in sustained reduction in invasive interventions for low-risk febrile infants without missed SBIs. Clinical pathways and QI can be key strategies in the delivery of evidence-based care for febrile infants.

Janani-Shishu Suraksha Karyakram (JSSK) and Janani Suraksha Yojana (JSY) were launched with the objective of increasing institutional deliveries. But, its knowledge among the post-natal mothers is not known. This research evaluated the knowledge of two national health programs among post-natal mothers and found out the predictors of good knowledge about the entitlements of these programs. A cross-sectional study was conducted on a sample of consecutively recruited 339 post-natal mothers who had delivered in a tertiary care hospital of western India. Data were collected from November 2016 to February 2017 by interview method using a questionnaire with questions about knowledge regarding the entitlements of JSSK and JSY. Multivariable analysis was carried out for predictors of good knowledge. Among the 339 post-natal mothers, 30% had a good knowledge regarding JSSK. Only 24% had heard about JSSK; 54% knew regarding free transport to the place of delivery; only 22% and 13%, respectively knew about free inter-facility transport in case of complications for pregnant women and sick infants, while 96% knew regarding free drop-back facility. Only one-fourth of the mothers knew regarding monetary benefit under JSY, while 28% of them had actually received the benefit. The number of antenatal care visits, having an occupation and belonging to Hindu religion significantly predicts good knowledge among postnatal mothers regarding JSSK. Knowledge among the post-natal mothers regarding the entitlements of JSSK and JSY is less while comparing with published literature and needs improvement. Regular ante-natal care (ANC) visits might improve their knowledge of these programs. There is a need to create awareness among hospital staff for the provision of reimbursement of costs incurred by post-natal mothers. There is also a need to carry out demand generation activities among mothers regarding the entitlements of JSSK and JSY.