A new study from Harvard School of Public Health (HSPH) and the World Health Organization (WHO) finds that a simple checklist-based patient safety programme for childbirth dramatically improved adherence to essential childbirth care practices at a pilot hospital in South India. Of 29 practices measured, 28 were improved after adoption of the checklist and overall adherence to essential practices more than doubled after the checklist was introduced.
The study appears in the May 16, 2012 online edition of PLoS ONE at http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0035151
There are nearly 300,000 maternal deaths, 3.1 million newborn deaths, and 1.2 million intrapartum-related stillbirths taking place in low-income countries each year, of which the vast majority are preventable. This study offers “hope that use of this simple, low-cost tool can help birth attendants better adhere to universally accepted standards in childbirth care,” as indicated senior author Atul Gawande, Associate Professor in Health Policy and Management at HSPH and lead advisor for WHO Patient Safety’s childbirth and surgery safety checklist-based patient safety programmes.
This prospective before and after intervention study took place over six months at a First Referral Unit (level-II) birth facility located in Karnataka, India. The Safe Childbirth Checklist (SCC) programme led to dramatic improvements in healthcare worker adherence to essential childbirth-related clinical care standards. Healthcare workers provided on average 10 out of 29 (34%) essential clinical care standards at baseline and 25 out of 29 (86%) after introduction of the checklist (p<0.001). For example, rates of breastfeeding within 1 hour after birth increased from 50.4% to 94.6%.
The WHO Safe Childbirth Checklist builds on the success of the WHO Surgical Safety Checklist and targets the major causes of morbidity and mortality in mothers and their newborn babies around the time of delivery. It defines a core set of practical standards to enhance patient safety and includes a behaviour change package to help staff implement the checklist. At the programme’s core is a checklist that helps to ensure adherence to essential childbirth practices known to be associated with improved maternal, foetal, and neonatal health. Each item is a critical action that is commonly missed but proven to reduce complications and deaths.
A large Ramdomised Controlled Trial led by researchers from Harvard School of Public Health and funded by the Bill and Melinda Gates Foundation is underway in Uttar Pradesh, India to evaluate the impact of this checklist-based patient safety programme on maternal and newborn health outcomes. Results of the study are expected by 2015.
The Safe Childbirth Checklist programme represents a collaborative effort of the WHO Patient Safety Programme, the Department of Maternal, Newborn, Child and Adolescent Health, and the Department of Reproductive Health and Research and Harvard School of Public Health, in addition to many other experts from around the world. WHO anticipates a draft release of the WHO Safe Childbirth Checklist by the end of the year.