Accreditation of birth centres: advantages for newborns.

Unlabelled: Accreditation or certification of Health Care Providers is a crucial tool to improve health care quality, and to promote excellence. Excellent healthcare should have the following six characteristics: Safe, Effective, Person-centred, Timely, Efficient, Equitable. Safety in health care should consider the analysis and reduction of medical systematic errors and their related patients' harm. In 1999 the U.S. Institute of Medicine defined medical errors as the failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aim. In neonatal intensive care units and pediatric intensive care units the areas most frequently associated with medical errors are medication, including prescribing, preparation, administration and monitoring; health-care associated infections; mechanical ventilation; events related to the use of medical devices or procedures and, more recently, caregivers fatigue and communication strategies. In Italy, Maternal-Neonatal Health is one of the national priorities, but there are still wide and deep differences among Regions. In 2008, more than 9% of the deliveries occurred in Hospitals with less than 500 births per year, a volume considered too small to guarantee optimal standard of care. In 2010, the National Government and the Regional Health Authorities agreed to set to 1000 births/year the standard threshold for Hospital Birth Centers, considering the same volume for obstetric-gynecologic and neonatal-pediatrics Units. Despite most indicators attest the good performance of the National health care, a further area to be addressed is the perception of its quality by the people. The discrepancy between quality of care and its public perception is in fact reported in many industrialized countries. Accreditation programs can improve the availability and access to a standardized quality of care. A well-established worldwide accreditation program is led by Joint Commission International (JCI). As far as accreditation of perinatal care is regarded, in 2010 the U.S. Joint Commission has defined a set of measures known as the perinatal care core measure set, which consider elective delivery, cesarean section, antenatal steroids, healthcare-associated bloodstream infections in newborns, exclusive breastmilk feeding. In Italy, the 2011-2013 National Health Care Plan underline the need for developing and implementing certification programs for Hospital Birth Centers. In 2011, a multidisciplinary working group (Italian Group for Safe Birth) has thus been established.

Conclusion: the main goal of each Health Care Organization should be to achieve the best quality and safety. Health Care Organizations must reduce random variations and improve activities by a standardized process whose results can be measured both in terms of patients outcome and in terms of transparency of each activity. Newborn and infants are one of the weakest population group; to improve their health outcome is thus mandatory to do all efforts to obtain a safe, effective, efficient and patient-centered health care assistance.