PMID- 35288391 OWN - NLM STAT- MEDLINE DCOM- 20220405 LR - 20220524 IS - 2044-6055 (Electronic) IS - 2044-6055 (Linking) VI - 12 IP - 3 DP - 2022 Mar 14 TI - Impact of the implementation of the WHO Safe Childbirth Checklist on essential birth practices and adverse events in two Brazilian hospitals: a before and after study. PG - e056908 LID - 10.1136/bmjopen-2021-056908 [doi] LID - e056908 AB - OBJECTIVE: The WHO Safe Childbirth Checklist (SCC) is a promising initiative for safety in childbirth care, but the evidence about its impact on clinical outcomes is limited. This study analysed the impact of SCC on essential birth practices (EBPs), obstetric complications and adverse events (AEs) in hospitals of different profiles. DESIGN: Quasi-experimental, time-series study and pre/post intervention. SETTING: Two hospitals in North-East Brazil, one at a tertiary level (H1) and another at a secondary level (H2). PARTICIPANTS: 1440 women and their newborns, excluding those with congenital malformations. INTERVENTIONS: The implementation of the SCC involved its cross-cultural adaptation, raising awareness with videos and posters, learning sessions about the SCC and auditing and feedback on adherence indicators. PRIMARY AND SECONDARY OUTCOME MEASURES: Simple and composite indicators related to seven EBPs, 3 complications and 10 AEs were monitored for 1 year, every 2 weeks, totalling 1440 observed deliveries. RESULTS: The checklist was adopted in 83.3% (n=300) of deliveries in H1 and in 33.6% (n=121) in H2. The hospital with the highest adoption rate for SCC (H1) showed greater adherence to EBPs (improvement of 50.9%;p<0.001) and greater reduction in clinical outcome indicators compared with its baseline: percentage of deliveries with severe complications (reduction of 30.8%;p=0.005); Adverse Outcome Index (reduction of 25.6%;p=0.049); Weighted Adverse Outcome Score (reduction of 39.5%;p<0.001); Severity Index (reduction of 18.4%;p<0.001). In H2, whose adherence to the SCC was lower, there was an improvement of 24.7% compared with before SCC implementation in the composite indicator of EBPs (p=0.002) and a reduction of 49.2% in severe complications (p=0.027), but there was no significant reduction in AEs. CONCLUSIONS: A multifaceted SCC-based intervention can be effective in improving adherence to EBPs and clinical outcomes in childbirth. The context and adherence to the SCC seem to modulate its impact, working better in a hospital of higher complexity. CI - (c) Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. FAU - Sousa, Kelienny de Meneses AU - Sousa KM AUID- ORCID: 0000-0001-6842-7033 AD - Graduate Program in Collective Health, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil. AD - QualiSaude-The Quality in Health Services Research Group, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil. FAU - Saturno-Hernandez, Pedro Jesus AU - Saturno-Hernandez PJ AD - QualiSaude-The Quality in Health Services Research Group, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil. AD - Centro de Investigacion en Evaluacion y Encuestas, Instituto Nacional de Salud Publica, Cuernavaca, Morelos, Mexico. FAU - Rosendo, Tatyana Maria Silva de Souza AU - Rosendo TMSS AD - QualiSaude-The Quality in Health Services Research Group, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil. AD - Department of Public Health, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil. FAU - Freitas, Marise Reis de AU - Freitas MR AD - QualiSaude-The Quality in Health Services Research Group, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil. AD - Department of Infectious Diseases, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil. FAU - Molina, Rose L AU - Molina RL AD - Department of Obstetrics and Gynaecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA. AD - Ariadne Labs, Brigham and Women's Hospital and Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA. FAU - Medeiros, Wilton Rodrigues AU - Medeiros WR AD - QualiSaude-The Quality in Health Services Research Group, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil. AD - Ana Bezerra University Hospital, Federal University of Rio Grande do Norte, Santa Cruz, Rio Grande do Norte, Brazil. FAU - Silva, Edna Marta Mendes da AU - Silva EMMD AD - QualiSaude-The Quality in Health Services Research Group, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil. AD - Maternity School Januario Cicco, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil. FAU - Gama, Zenewton Andre da Silva AU - Gama ZADS AUID- ORCID: 0000-0003-0818-9680 AD - Graduate Program in Collective Health, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil zenewton.gama@ufrn.br. AD - QualiSaude-The Quality in Health Services Research Group, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil. AD - Department of Public Health, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20220314 PL - England TA - BMJ Open JT - BMJ open JID - 101552874 SB - IM MH - Brazil MH - *Checklist MH - *Delivery, Obstetric MH - Female MH - Hospitals MH - Humans MH - Infant, Newborn MH - Pregnancy MH - World Health Organization PMC - PMC8921924 OTO - NOTNLM OT - health & safety OT - obstetrics OT - public health OT - quality in health care COIS- Competing interests: None declared. EDAT- 2022/03/16 06:00 MHDA- 2022/04/05 06:00 PMCR- 2022/03/14 CRDT- 2022/03/15 05:42 PHST- 2022/03/15 05:42 [entrez] PHST- 2022/03/16 06:00 [pubmed] PHST- 2022/04/05 06:00 [medline] PHST- 2022/03/14 00:00 [pmc-release] AID - bmjopen-2021-056908 [pii] AID - 10.1136/bmjopen-2021-056908 [doi] PST - epublish SO - BMJ Open. 2022 Mar 14;12(3):e056908. doi: 10.1136/bmjopen-2021-056908.