Effects of the World Health Organization Safe Childbirth Checklist on Quality of Care and Birth Outcomes in Aceh, Indonesia: A Cluster-Randomized Clinical Trial

Impact of comprehensive quality improvement program on outcomes in very-low-birth-weight infants: A cluster-randomized controlled trial in Japan

BACKGROUND

Differences in outcomes among neonatal intensive care units (NICUs) in Japan have been noted, prompting the need for quality improvement.

AIM

To assess a comprehensive quality improvement program on outcomes in very-low-birth-weight (VLBW) infants.

STUDY DESIGN

A cluster-randomized clinical trial.

SUBJECTS

Forty hospitals and VLBW infants born in 2012-2014 and admitted to those hospitals were study subjects.

OUTCOME MEASURES

The intervention group (IG) received a comprehensive quality improvement program involving clinical practice guidelines, educational outreach visits, workshops, opinion leader training, audits, and feedback. The control group (CG) was provided only with the guidelines. The primary outcome was survival without neurological impairment at three years of age.

RESULTS

IG consisted of 19 hospitals and 1735 infants, while CG included 21 hospitals and 1700 infants. There were no significant differences in gestational weeks, 29.1(26.9-31.3) vs. 29.1(26.7-31.1) or birth weights (g), 1054(789-1298) vs. 1084(810-1309) between the two groups. Both groups showed survival rates without neurological impairment of 67.2 % (1166) and 66.9 % (1137), respectively, without a significant difference. There was no significant difference in mortalities at NICU discharge between the groups, with rates of 4.0 % (70) and 4.2 % (72) respectively. Several clinically relevant improvements were observed in IG, including reduced rates of sepsis, adrenal insufficiency, transfusion for anemia, and a shorter interval to achieve full enteral feeding. However, these did not lead to improvements in the primary outcome.

CONCLUSION

The comprehensive quality improvement program to Japanese NICUs did not result in a significant improvement in survival without neurological impairment in VLBW infants.

The effect of the WHO Safe Childbirth Checklist on essential delivery practices and birth outcomes: Evidence from a pair-wise matched randomized controlled trial in Pakistan

We study the effect of the Safe Childbirth Checklist (SCC) - a tool developed by the WHO to improve the quality of delivery care - on a range of provider- and patient-level outcomes. We conducted a clustered pair-wise matched randomized controlled trial among 166 health providers in two districts of Pakistan. This included primary and secondary health facilities as well as non-facility based rural health workers. We do not find positive effects on health outcomes, but on the adherence to some essential delivery practices, mostly to those conducted during the patient's admission to the delivery ward. We also find increased rates of referrals to higher-level facilities.

Impact of the WHO Safe Childbirth Checklist on safety culture among health workers: A randomized controlled trial in Aceh, Indonesia

The World Health Organization (WHO) developed the Safe Childbirth Checklist (SCC) to increase the application of essential birth practices to ultimately reduce perinatal and maternal deaths. We study the effects of the SCC on health workers safety culture, in the framework of a cluster-randomized controlled trial (16 treatment facilities/16 control facilities). We introduced the SCC in combination with a medium intensity coaching in health facilities which already offered at minimum basic emergency obstetric and newborn care (BEMonC). We assess the effects of using the SCC on 14 outcome variables measuring self-perceived information access, information transmission, frequency of errors, workload and access to resources at the facility level. We apply Ordinary Least Square regressions to identify an Intention to Treat Effect (ITT) and Instrumental Variable regressions to determine a Complier Average Causal Effect (CACE). The results suggest that the treatment significantly improved self-assessed attitudes regarding the probability of calling attention to problems with patient care (ITT 0.6945 standard deviations) and the frequency of errors in times of excessive workload (ITT -0.6318 standard deviations). Moreover, self-assessed resource access increased (ITT 0.6150 standard deviations). The other eleven outcomes were unaffected. The findings suggest that checklists can contribute to an improvement in some dimensions of safety culture among health workers. However, the complier analysis also highlights that achieving adherence remains a key challenge to make checklists effective.

Application of the PDCA cycle for implementing the WHO Safe Childbirth Checklist in women with vaginal deliveries

The World Health Organization Safe Childbirth Checklist (SCC) has been recommended globally. However, the results are inconsistent. The aim of this study was to investigate the effectiveness of implementing the SCC based on plan-do-check-act (PDCA) cycle management. From November 2019 to October 2020, women who were hospitalized and had vaginal deliveries were enrolled in this study. Before October 2020, the PDCA cycle was not applied for the SCC, and women who had vaginal deliveries were included in the pre-intervention group. From January 2021 to December 2021, the PDCA cycle was applied for the SCC, and women who had vaginal deliveries were included in the post-intervention group. The SCC utilization rate and the incidence of maternal and neonatal complications were compared between the 2 groups. The SCC utilization rate in the post-intervention group was higher than that in the pre-intervention group (P < .01). The postpartum infection rate in the post-intervention group was lower than that in the pre-intervention group, and the difference was statistically significant (P < .05). After the intervention, postpartum hemorrhage, neonatal mortality, and neonatal asphyxia rates were also reduced, although no significant differences were observed between the 2 groups. There was no significant difference in the third-degree perineal laceration or neonatal intensive care unit hospitalization rate between the 2 groups (P > .05). Application of the PDCA cycle can improve the SCC utilization rate, and the SCC combined with the PDCA cycle can effectively reduce the postpartum infection rate.

Performance checklist and its influence on knowledge and satisfaction of intensive care nurses: A quasi-experimental study

AIM

The purpose of this study was to evaluate the impact of using a performance checklist on knowledge and satisfaction of intensive care nurses.

METHOD

This study was a quasi-experimental study and performed on 70 intensive care nurses in two groups. Performance checklists had to be filled by the nurses in experiment group during central venous pressure (CVP) measurement procedure. Knowledge and the nurses about standards of CVP measurement and their satisfaction were evaluated in both groups by a researcher-made questionnaire. The data were analysed using the SPSS software.

RESULTS

In the experiment group, the level of knowledge significantly increased after the intervention (p = .001) and the majority of nurses (85.7%) had a high level of satisfaction. Also, there was a significant difference between mean knowledge scores of the two groups after the intervention (p = .006).

CONCLUSION

This showed that applying performance checklists can influence nurses' knowledge and should consider a simple indirect educational method.