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PIECING TOGETHER SAFE CHILDBIRTH
Exploring Simple, Life-Saving Checks Across the Childbirth Continuum




                      Every Woman Every Child
                     Innovation Working Group
                      Task Force on Checklists
                        Interim Progress Report
                               April 2012
Surgical Checklist: Results
            Results – All Sites

                        Baseline   Checklist   P value

Cases                   3733       3955             -

Death                   1.5%       0.8%        0.003

Any Complication        11.0%      7.0%        <0.001

SSI                     6.2%       3.4%        <0.001

Unplanned Reoperation   2.4%       1.8%        0.047
Checklists: Theories of Change

• Prompt at key moments in care
• Define essential tasks
• Highlight system malfunction
• Impose conceptual structure
• Increase team communication
• Facilitate essential dialogue
EWEC IWG Checklist TF
        Strategy Selection Criteria

•   Potential impact
•   Simplicity & user-friendliness
•   Feasibility for testing
•   Feasibility for scaling
•   Applicability across countries
•   Link to EWEC goals
Piece 2: At the Time of Delivery
Childbirth Checklist: Pause Points
                                                               Pause point #2
                                                                                          Pause point #3
                                                             Just before pushing
                                                                                         Soon after birth
                                                            (or before Cesarean)
                                     Pause point #1                                      (within 1 hour)
                                     On admission
                                                                                                               Pause point #4
                                                                              Delivery                        Before Discharge
Maternal & neonatal mortality risk




                                                      Labor progression                    Postpartum

                                            Admission to birth facility                  Discharge from birth facility

                                            Labor onset

                                         Antenatal period                                                        28 days

                                        Conception

                                                                                                                    42 days
                                       Pre-conception

                                                                               Time
Safe Childbirth Checklist Program
Safe Childbirth Checklist Program
Piece 1: During Pregnancy
Piece 3: In the Postpartum/Postnatal Period
Acknowledgments
      IWG Task Force on Checklists
Chairs
Scott Ratzan, Jonathan Spector
Members
Angela Lashoher, Claire Lemer, Sarah Marsh, Garrett Mehl, Marc
Mitchell, Ida Neuman, Prabhjot Singh
Advisory Group
Franklin Apfel, Gary Darmstadt, Lord Darzi of Denham, Karlee Sliver,
Bruce Gellin, Atul Gawande, Barry Bloom, Flavia Bustreo, Ian Pett,
Anayda Portela, Mario Merialdi, Patricia Mechael, Jean-Marie Okwo-
Bele, Ian Pett, Joanna Rubenstein, Sonia Ehrlich Sachs, Alexandra
Schoeb, Karlee Silver, Severin von Xylander
Support
Alice Fabiano, Grace Galvin, Amanda McKelvey, and Ade Obayemi

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Simple, life-saving checks across the childbirth continuum

  • 1. PIECING TOGETHER SAFE CHILDBIRTH Exploring Simple, Life-Saving Checks Across the Childbirth Continuum Every Woman Every Child Innovation Working Group Task Force on Checklists Interim Progress Report April 2012
  • 2.
  • 3.
  • 4.
  • 5. Surgical Checklist: Results Results – All Sites Baseline Checklist P value Cases 3733 3955 - Death 1.5% 0.8% 0.003 Any Complication 11.0% 7.0% <0.001 SSI 6.2% 3.4% <0.001 Unplanned Reoperation 2.4% 1.8% 0.047
  • 6. Checklists: Theories of Change • Prompt at key moments in care • Define essential tasks • Highlight system malfunction • Impose conceptual structure • Increase team communication • Facilitate essential dialogue
  • 7. EWEC IWG Checklist TF Strategy Selection Criteria • Potential impact • Simplicity & user-friendliness • Feasibility for testing • Feasibility for scaling • Applicability across countries • Link to EWEC goals
  • 8.
  • 9. Piece 2: At the Time of Delivery
  • 10. Childbirth Checklist: Pause Points Pause point #2 Pause point #3 Just before pushing Soon after birth (or before Cesarean) Pause point #1 (within 1 hour) On admission Pause point #4 Delivery Before Discharge Maternal & neonatal mortality risk Labor progression Postpartum Admission to birth facility Discharge from birth facility Labor onset Antenatal period 28 days Conception 42 days Pre-conception Time
  • 13. Piece 1: During Pregnancy
  • 14. Piece 3: In the Postpartum/Postnatal Period
  • 15. Acknowledgments IWG Task Force on Checklists Chairs Scott Ratzan, Jonathan Spector Members Angela Lashoher, Claire Lemer, Sarah Marsh, Garrett Mehl, Marc Mitchell, Ida Neuman, Prabhjot Singh Advisory Group Franklin Apfel, Gary Darmstadt, Lord Darzi of Denham, Karlee Sliver, Bruce Gellin, Atul Gawande, Barry Bloom, Flavia Bustreo, Ian Pett, Anayda Portela, Mario Merialdi, Patricia Mechael, Jean-Marie Okwo- Bele, Ian Pett, Joanna Rubenstein, Sonia Ehrlich Sachs, Alexandra Schoeb, Karlee Silver, Severin von Xylander Support Alice Fabiano, Grace Galvin, Amanda McKelvey, and Ade Obayemi