{
  "abstract": "Background Maternal mortality in Brazil remains elevated despite local initiatives. The TeleICU Obstetric (TIO) project was created to assist intensive care units in reference obstetric hospitals.Methods 25 Brazilian hospitals were selected by the Ministry of Health for the TIO programme, running from April 2022 to May 2024. The programme included teletraining for multidisciplinary teams, teleinterconsultations with specialists and monitoring of maternal health indicators. Training modalities included asynchronous, synchronous and in loco formats. Teleinterconsultations were conducted between hospital professionals and the obstetrics team and intensivists from Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, available 7 days a week. The maternal mortality ratio (MMR) was calculated for the 6 months prior to the project (baseline) and for the 7 months following its implementation.Findings Median project participation was 7 (6–10) months. Training was completed by 564 professionals (asynchronous), 1707 (synchronous) and 831 (in loco), with a Net Promoter Score of 85 (81–92), 100 (93–100) and 95 (92–100), respectively. Teleinterconsultations assisted 1351 patients across 4556 sessions. 16 hospitals provided full data for analysis. MMR reduced significantly by 45% (p<0.05), from 190 (63–346) pre-intervention to 104 (55–213) during implementation.Interpretation The TIO project is feasible and scalable for other economically disadvantaged countries facing similar challenges to reducing maternal mortality.",
  "authors": [
    {
      "affiliations": [
        "Saude Digital, Nucleo de Inovacao Tecnologica (InovaHC), Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil",
        "Divisao de Pneumologia, Instituto do Coracao (InCor), Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil"
      ],
      "name": "Carlos R R Carvalho"
    },
    {
      "affiliations": [
        "Saude Digital, Nucleo de Inovacao Tecnologica (InovaHC), Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil"
      ],
      "name": "Pedro Rizzi de Oliveira"
    },
    {
      "affiliations": [
        "Saude Digital, Nucleo de Inovacao Tecnologica (InovaHC), Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil"
      ],
      "name": "Thais Suemi Yokoyama"
    },
    {
      "affiliations": [
        "Saude Digital, Nucleo de Inovacao Tecnologica (InovaHC), Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil"
      ],
      "name": "Jhenifer Melissa de Oliveira Correia"
    },
    {
      "affiliations": [
        "Saude Digital, Nucleo de Inovacao Tecnologica (InovaHC), Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil"
      ],
      "name": "Diego Campos Gonzalez"
    },
    {
      "affiliations": [
        "Saude Digital, Nucleo de Inovacao Tecnologica (InovaHC), Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil"
      ],
      "name": "Paula Gobi Scudeller"
    },
    {
      "affiliations": [
        "Departamento de Obstetricia e Ginecologia, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil"
      ],
      "name": "Carolina Burgarelli Testa"
    },
    {
      "affiliations": [
        "Departamento de Obstetricia e Ginecologia, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil"
      ],
      "name": "Veridiana Franco"
    },
    {
      "affiliations": [
        "Departamento de Obstetricia e Ginecologia, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil"
      ],
      "name": "Fernanda Spadotto Baptista"
    },
    {
      "affiliations": [
        "Ministerio da Saude, Brasília, Brazil",
        "Fundacao Getulio Vargas Escola de Administracao de Empresas de Sao Paulo, São Paulo, SP, Brazil"
      ],
      "name": "Adriano Massuda"
    },
    {
      "affiliations": [
        "Saude Digital, Nucleo de Inovacao Tecnologica (InovaHC), Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil",
        "Divisao de Pneumologia, Instituto do Coracao (InCor), Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil"
      ],
      "name": "Martina Rodrigues de Oliveira"
    },
    {
      "affiliations": [
        "Saude Digital, Nucleo de Inovacao Tecnologica (InovaHC), Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil"
      ],
      "name": "Celina de Almeida Lamas"
    },
    {
      "affiliations": [
        "Departamento de Obstetricia e Ginecologia, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil"
      ],
      "name": "Rossana Pulcineli Vieira Francisco"
    },
    {
      "affiliations": [],
      "name": "TeleICU Obstetrics Study Group"
    }
  ],
  "title": "TeleICU obstetrics: a strategy to decrease maternal mortality in Brazil",
  "uid": "9305dba2-ca06-59d7-be26-dd24c644bab1"
}