Evaluation of an international educational programme for health care professionals on best practice in the management of a perinatal death: IMproving Perinatal mortality Review and Outcomes Via Education (IMPROVE)

Abstract

BackgroundStillbirths and neonatal deaths are devastating events for both parents and clinicians and are global public health concerns. Careful clinical management after these deaths is required, including appropriate investigation and assessment to determine cause (s) to prevent future losses, and to improve bereavement care for families. An educational programme for health care professionals working in maternal and child health has been designed to address these needs according to the Perinatal Society of Australia and New Zealand Guideline for Perinatal Mortality: IMproving Perinatal mortality Review and Outcomes Via Education (IMPROVE). The programme has a major focus on stillbirth and is delivered as six interactive skills-based stations. We aimed to determine participants’ pre- and post-programme knowledge of and confidence in the management of perinatal deaths, along with satisfaction with the programme. We also aimed to determine suitability for international use.MethodsThe IMPROVE programme was delivered to health professionals in maternity hospitals in all seven Australian states and territories and modified for use internationally with piloting in Vietnam, Fiji, and the Netherlands (with the assistance of the International Stillbirth Alliance, ISA). Modifications were made to programme materials in consultation with local teams and included translation for the Vietnam programme. Participants completed pre- and post-programme evaluation questionnaires on knowledge and confidence on six key components of perinatal death management as well as a satisfaction questionnaire.ResultsOver the period May 2012 to May 2015, 30 IMPROVE workshops were conducted, including 26 with 758 participants in Australia and four with 136 participants internationally. Evaluations showed a significant improvement between pre- and post-programme knowledge and confidence in all six stations and overall, and a high degree of satisfaction in all settings.ConclusionsThe IMPROVE programme has been well received in Australia and in three different international settings and is now being made available through ISA. Future research is required to determine whether the immediate improvements in knowledge are sustained with less causes of death being classified as unknown, changes in clinical practice and improvement in parents’ experiences with care. The suitability for this programme in low-income countries also needs to be established.

The incidence of fatal fetal anomalies associated with perinatal mortality in Ireland

“…The findings of low uptake of autopsy and suboptimal investigations are similar to national and international studies that addressed autopsy rates of all perinatal deaths . Autopsy and postnatal investigations are essential to explore the underlying reasons for perinatal mortality thus informing perinatal audit .…”

The feasibility of a clinical audit tool to investigate stillbirth in Australia – a single centre experience

“…identified autopsy as an effective intervention in HICs to maximise wellbeing for bereaved parents and families. By implementing educational programs for clinical staff such as IMPROVE (IMproving Perinatal Review and Outcomes via Education), hospitals ensure that standards of clinical practice are in line with PSANZ Perinatal Mortality Guidelines. Clinicians in maternity units throughout Australia have been encouraged to attend these programs in recent years, focusing on improved counselling techniques regarding perinatal autopsy.…”

“…Clinicians in maternity units throughout Australia have been encouraged to attend these programs in recent years, focusing on improved counselling techniques regarding perinatal autopsy. Such programs assist healthcare professionals in Australia to implement prevention strategies and enhance care of parents around the devastating time of stillbirth …”

USA Child (0-4) and Adult (55-74) Mortality and % GDP-Health Expenditure and the Other Western Countries 1989-2015. America needs an “National Neighbourhood Health Service”

“…These include low birth weight [10,11], parental smoking [12], drug and alcohol misuse [13], living in deprived polluted areas [14], social inequalities associated with poorer education, anti and post-natal care [6][7][8][9]15] and belonging to an ethnic minority [16]. Though the above factors are themselves linked to relative poverty in the West [2,[6][7][8][9][10][11][12][13][14][15][16]. Moreover, the UN Millennium goals recognised that the aim of reducing child mortality by 2% pa also required the need to reduce relative poverty [2].…”