Safety and Quality of Maternal and Neonatal Pathway: A Pilot Study on the Childbirth Checklist in 9 Italian Hospitals

Maternal and neonatal mortality and morbidity associated with childbirth is a global health problem of the highest priority. Of the more than 130 million births each year, the WHO estimates that about 287.000 are maternal deaths, 1 million fetal deaths during intra-partum period and 3 million deaths of infants during the neonatal period. In low- and middle-income countries, low levels of quality and safety of care still represent an important “issue”. The presence of protocols, procedures and cognitive support tools represent still key factors along with procedure for integration with the territory, continuity of care at birth path. In high-income countries the use of tools to support the work of health workers with the aim of managing clinical risk and improving patient safety, is quite usual. The pilot study aims to design and to test a safety checklist for supporting sharp-end healthcare workers coping with critical activities during delivery. The pilot study is based on quantitative analyses to evaluate the tool in terms of usability, feasibility and impact on team working, communication among member's team and work organization. The evaluation process related to the pilot allowed the researchers to collect very interesting input from the clinicians aimed at improving the tool in terms of usability and patient safety. Implications for the theory are the redesign of some areas of the checklist according to the specific organization of a delivery center. The pilot study also allowed the researcher to engage clinicians thanks to their direct involvement in designing the best solution that can fit their daily work. The checklist, as most of the checklists in healthcare settings, promotes the interdisciplinary work, as the control process has to be done by different figures. This is still a big challenge. Implication for practice is the extension of the pilot at the regional level with the involvement of 3 teaching hospitals and the analysis of more than 3000 cases. The results of the extended pilot will constitute the basis for the participation to the WHO Safe Childbirth Checklist program.