Improving quality of care for maternal and newborn health: prospective pilot study of the WHO safe childbirth checklist program
Most maternal deaths, intrapartum-related stillbirths, and newborn deaths in low income countries are preventable but simple, effective methods for improving safety in institutional births have not been devised. Checklist-based interventions aid management of complex or neglected tasks and have been...
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| creator | Spector, Jonathan M Agrawal, Priya Kodkany, Bhala Lipsitz, Stuart Lashoher, Angela Dziekan, Gerald Bahl, Rajiv Merialdi, Mario Mathai, Matthews Lemer, Claire Gawande, Atul |
| description | Most maternal deaths, intrapartum-related stillbirths, and newborn deaths in low income countries are preventable but simple, effective methods for improving safety in institutional births have not been devised. Checklist-based interventions aid management of complex or neglected tasks and have been shown to reduce harm in healthcare. We hypothesized that implementation of the WHO Safe Childbirth Checklist program, a novel childbirth safety program for institutional births incorporating a 29-item checklist, would increase delivery of essential childbirth practices linked with improved maternal and perinatal health outcomes.
A pilot, pre-post-intervention study was conducted in a sub-district level birth center in Karnataka, India between July and December 2010. We prospectively observed health workers that attended to women and newborns during 499 consecutively enrolled birth events and compared these with observed practices during 795 consecutively enrolled birth events after the introduction of the WHO Safe Childbirth Checklist program. Twenty-nine essential practices that target the major causes of childbirth-related mortality, such as hand hygiene and uterotonic administration, were evaluated. The primary end point was the average rate of successful delivery of essential childbirth practices by health workers. Delivery of essential childbirth-related care practices at each birth event increased from an average of 10 of 29 practices at baseline (95%CI 9.4, 10.1) to an average of 25 of 29 practices afterwards (95%CI 24.6, 25.3; p |
| doi_str_mv | 10.1371/journal.pone.0035151 |
| format | Article |
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A pilot, pre-post-intervention study was conducted in a sub-district level birth center in Karnataka, India between July and December 2010. We prospectively observed health workers that attended to women and newborns during 499 consecutively enrolled birth events and compared these with observed practices during 795 consecutively enrolled birth events after the introduction of the WHO Safe Childbirth Checklist program. Twenty-nine essential practices that target the major causes of childbirth-related mortality, such as hand hygiene and uterotonic administration, were evaluated. The primary end point was the average rate of successful delivery of essential childbirth practices by health workers. Delivery of essential childbirth-related care practices at each birth event increased from an average of 10 of 29 practices at baseline (95%CI 9.4, 10.1) to an average of 25 of 29 practices afterwards (95%CI 24.6, 25.3; p<0.001). There was significant improvement in the delivery of 28 out of 29 individual practices. No adverse outcomes relating to the intervention occurred. Study limitations are the pre-post design, potential Hawthorne effect, and focus on processes of care versus health outcomes.
Introduction of the WHO Safe Childbirth Checklist program markedly improved delivery of essential safety practices by health workers. Future study will determine if this program can be implemented at scale and improve health outcomes.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0035151</identifier><identifier>PMID: 22615733</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Archives & records ; Behavior modification ; Biometrics ; Birth ; Births ; Catheters ; Child Health Services - standards ; Child mortality ; Childbirth & labor ; Children & youth ; Clinical medicine ; Data analysis ; Delivery (Childbirth) ; Epidemiology ; Fatalities ; Female ; Guidelines as Topic ; Health aspects ; Health care ; Hospitals ; Humans ; Hygiene ; India ; Infant mortality ; Infant, Newborn ; Intensive care ; Intervention ; Low income areas ; Maternal Health Services - standards ; Maternal mortality ; Medical care quality ; Medical personnel ; Medicine ; Methods ; Morbidity ; Neonates ; Newborn babies ; Newborn infants ; Patient safety ; Personal hygiene ; Physicians ; Pilot Projects ; Prospective Studies ; Public health ; Quality of Health Care ; Safety ; Safety and security measures ; Safety programs ; Surgery ; Task complexity ; Womens health ; Workers ; World Health Organization</subject><ispartof>PloS one, 2012-05, Vol.7 (5), p.e35151-e35151</ispartof><rights>COPYRIGHT 2012 Public Library of Science</rights><rights>2012 Spector et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License: https://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>Spector et al. 2012</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c758t-8ee15e92e11a843a82a993151cef6b808a6cdc2ef0c83688ed093d69ab36154f3</citedby><cites>FETCH-LOGICAL-c758t-8ee15e92e11a843a82a993151cef6b808a6cdc2ef0c83688ed093d69ab36154f3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3353951/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3353951/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,315,728,781,785,865,886,2103,2929,23871,27929,27930,53796,53798</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22615733$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Middleton, Philippa</contributor><creatorcontrib>Spector, Jonathan M</creatorcontrib><creatorcontrib>Agrawal, Priya</creatorcontrib><creatorcontrib>Kodkany, Bhala</creatorcontrib><creatorcontrib>Lipsitz, Stuart</creatorcontrib><creatorcontrib>Lashoher, Angela</creatorcontrib><creatorcontrib>Dziekan, Gerald</creatorcontrib><creatorcontrib>Bahl, Rajiv</creatorcontrib><creatorcontrib>Merialdi, Mario</creatorcontrib><creatorcontrib>Mathai, Matthews</creatorcontrib><creatorcontrib>Lemer, Claire</creatorcontrib><creatorcontrib>Gawande, Atul</creatorcontrib><title>Improving quality of care for maternal and newborn health: prospective pilot study of the WHO safe childbirth checklist program</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Most maternal deaths, intrapartum-related stillbirths, and newborn deaths in low income countries are preventable but simple, effective methods for improving safety in institutional births have not been devised. Checklist-based interventions aid management of complex or neglected tasks and have been shown to reduce harm in healthcare. We hypothesized that implementation of the WHO Safe Childbirth Checklist program, a novel childbirth safety program for institutional births incorporating a 29-item checklist, would increase delivery of essential childbirth practices linked with improved maternal and perinatal health outcomes.
A pilot, pre-post-intervention study was conducted in a sub-district level birth center in Karnataka, India between July and December 2010. We prospectively observed health workers that attended to women and newborns during 499 consecutively enrolled birth events and compared these with observed practices during 795 consecutively enrolled birth events after the introduction of the WHO Safe Childbirth Checklist program. Twenty-nine essential practices that target the major causes of childbirth-related mortality, such as hand hygiene and uterotonic administration, were evaluated. The primary end point was the average rate of successful delivery of essential childbirth practices by health workers. Delivery of essential childbirth-related care practices at each birth event increased from an average of 10 of 29 practices at baseline (95%CI 9.4, 10.1) to an average of 25 of 29 practices afterwards (95%CI 24.6, 25.3; p<0.001). There was significant improvement in the delivery of 28 out of 29 individual practices. No adverse outcomes relating to the intervention occurred. Study limitations are the pre-post design, potential Hawthorne effect, and focus on processes of care versus health outcomes.
Introduction of the WHO Safe Childbirth Checklist program markedly improved delivery of essential safety practices by health workers. Future study will determine if this program can be implemented at scale and improve health outcomes.</description><subject>Archives & records</subject><subject>Behavior modification</subject><subject>Biometrics</subject><subject>Birth</subject><subject>Births</subject><subject>Catheters</subject><subject>Child Health Services - standards</subject><subject>Child mortality</subject><subject>Childbirth & labor</subject><subject>Children & youth</subject><subject>Clinical medicine</subject><subject>Data analysis</subject><subject>Delivery (Childbirth)</subject><subject>Epidemiology</subject><subject>Fatalities</subject><subject>Female</subject><subject>Guidelines as Topic</subject><subject>Health aspects</subject><subject>Health care</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Hygiene</subject><subject>India</subject><subject>Infant mortality</subject><subject>Infant, Newborn</subject><subject>Intensive care</subject><subject>Intervention</subject><subject>Low income areas</subject><subject>Maternal Health Services - standards</subject><subject>Maternal mortality</subject><subject>Medical care quality</subject><subject>Medical personnel</subject><subject>Medicine</subject><subject>Methods</subject><subject>Morbidity</subject><subject>Neonates</subject><subject>Newborn babies</subject><subject>Newborn infants</subject><subject>Patient safety</subject><subject>Personal hygiene</subject><subject>Physicians</subject><subject>Pilot Projects</subject><subject>Prospective Studies</subject><subject>Public health</subject><subject>Quality of Health Care</subject><subject>Safety</subject><subject>Safety and security measures</subject><subject>Safety programs</subject><subject>Surgery</subject><subject>Task complexity</subject><subject>Womens health</subject><subject>Workers</subject><subject>World Health 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health: prospective pilot study of the WHO safe childbirth checklist program</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2012-05-16</date><risdate>2012</risdate><volume>7</volume><issue>5</issue><spage>e35151</spage><epage>e35151</epage><pages>e35151-e35151</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Most maternal deaths, intrapartum-related stillbirths, and newborn deaths in low income countries are preventable but simple, effective methods for improving safety in institutional births have not been devised. Checklist-based interventions aid management of complex or neglected tasks and have been shown to reduce harm in healthcare. We hypothesized that implementation of the WHO Safe Childbirth Checklist program, a novel childbirth safety program for institutional births incorporating a 29-item checklist, would increase delivery of essential childbirth practices linked with improved maternal and perinatal health outcomes.
A pilot, pre-post-intervention study was conducted in a sub-district level birth center in Karnataka, India between July and December 2010. We prospectively observed health workers that attended to women and newborns during 499 consecutively enrolled birth events and compared these with observed practices during 795 consecutively enrolled birth events after the introduction of the WHO Safe Childbirth Checklist program. Twenty-nine essential practices that target the major causes of childbirth-related mortality, such as hand hygiene and uterotonic administration, were evaluated. The primary end point was the average rate of successful delivery of essential childbirth practices by health workers. Delivery of essential childbirth-related care practices at each birth event increased from an average of 10 of 29 practices at baseline (95%CI 9.4, 10.1) to an average of 25 of 29 practices afterwards (95%CI 24.6, 25.3; p<0.001). There was significant improvement in the delivery of 28 out of 29 individual practices. No adverse outcomes relating to the intervention occurred. Study limitations are the pre-post design, potential Hawthorne effect, and focus on processes of care versus health outcomes.
Introduction of the WHO Safe Childbirth Checklist program markedly improved delivery of essential safety practices by health workers. Future study will determine if this program can be implemented at scale and improve health outcomes.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>22615733</pmid><doi>10.1371/journal.pone.0035151</doi><tpages>e35151</tpages><oa>free_for_read</oa></addata></record> |
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| recordid | cdi_plos_journals_1324569957 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Public Library of Science (PLoS) Journals Open Access; EZB-FREE-00999 freely available EZB journals; PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Archives & records Behavior modification Biometrics Birth Births Catheters Child Health Services - standards Child mortality Childbirth & labor Children & youth Clinical medicine Data analysis Delivery (Childbirth) Epidemiology Fatalities Female Guidelines as Topic Health aspects Health care Hospitals Humans Hygiene India Infant mortality Infant, Newborn Intensive care Intervention Low income areas Maternal Health Services - standards Maternal mortality Medical care quality Medical personnel Medicine Methods Morbidity Neonates Newborn babies Newborn infants Patient safety Personal hygiene Physicians Pilot Projects Prospective Studies Public health Quality of Health Care Safety Safety and security measures Safety programs Surgery Task complexity Womens health Workers World Health Organization |
| title | Improving quality of care for maternal and newborn health: prospective pilot study of the WHO safe childbirth checklist program |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-12T03%3A13%3A38IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Improving%20quality%20of%20care%20for%20maternal%20and%20newborn%20health:%20prospective%20pilot%20study%20of%20the%20WHO%20safe%20childbirth%20checklist%20program&rft.jtitle=PloS%20one&rft.au=Spector,%20Jonathan%20M&rft.date=2012-05-16&rft.volume=7&rft.issue=5&rft.spage=e35151&rft.epage=e35151&rft.pages=e35151-e35151&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0035151&rft_dat=%3Cgale_plos_%3EA477077202%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1324569957&rft_id=info:pmid/22615733&rft_galeid=A477077202&rft_doaj_id=oai_doaj_org_article_cf834fc02a024642a7801f1c2edf5eb2&rfr_iscdi=true |