Busy day effect on intrapartum adverse maternal outcomes – a population‐based study of 601 247 singleton deliveries

Abstract

Background This was a retrospective population-based study, utilizing the data of 601 247 singleton hospital deliveries collected from the Finnish Medical Birth Register (MBR) in 2006–2016. The aim of this study was to analyse the busy day effect on intrapartum adverse maternal outcomes. Methods To implement the study design, daily delivery frequencies and ranges (min-max) for each delivery unit (n = 26) were stratified to the daily delivery volume distributions by the delivery unit’s annual delivery volume and profile: Category (C)1 < 1000, C2 1000–1999, C3 2000–2999, C4 ≥ 3000 and C5 the profile of university hospitals. To study the busy day effect, the quiet, optimal and busy days were defined by calculating the number of days (%) with the lowest and highest daily delivery frequencies and summed to the nearest 10 % in each hospital category. Optimal days were determined by calculating approximately 80 % of deliveries occurring between the lowest 10 %, and highest 10 % in each hospital category. Crude and adjusted odd ratios (ORs) with 99 % confidence intervals (CIs) were used to analyze the busy day effect on adverse maternal outcomes, blood transfusions, manual removal of the placenta and obstetric anal sphincter injuries, separately in each hospital category. Results The busy day effect was associated with the 28 % (99 % CI 8–52 %) and 25 % (99 % CI 11–40 %) increased need for blood transfusions in C2 and university hospitals (C5), respectively, whereas 22 % (99 % CI 10–31 %) less blood transfusions were needed at university hospitals during quiet days. In C3 hospitals, 83 % (99 % CI 65–92 %) less blood transfusions were needed during busy days. Obstetric and anal sphincter injury rates declined during quiet days by 22 % (99 % CI 3–38 %) only in university hospitals. Conclusions The findings of this study identify no specific pattern to the busy day effect for adverse maternal outcomes defined as manual removal of the placenta or obstetric and anal sphincter injuries. However, both quiet and busy days seem to be associated with increased or decreased need for blood transfusions in different sized delivery units. Findings also suggest that quiet days are associated with a decreased number of obstetric and anal sphincter injuries.

Comparison of Health Outcomes Among Patients Admitted on Busy vs Less Busy Days for Hospitalists

“…Prior studies have noted increased risk of harm to patients admitted to full intensive care units or obstetric floors. 5,6 Our analysis was at the clinician level and compared physicians with their own prior experience, rather than at the medical floor or team level, which may obscure consequences to the patient when other aspects of the care delivery team exceed a maximum number of patients. However, our findings are reassuring that hospitalists provide similar care regardless of their caseload, potentially from additional supportive coverage models or efforts by individual clinicians to offset busy work environments.…”

“…In this large, national cohort study with ample power to detect meaningful differences, we found small differences in hospitalists’ resource use and no substantive differences in patients’ outcomes during their busiest admission days compared with all other admission days for common medical admissions. Prior studies have noted increased risk of harm to patients admitted to full intensive care units or obstetric floors . Our analysis was at the clinician level and compared physicians with their own prior experience, rather than at the medical floor or team level, which may obscure consequences to the patient when other aspects of the care delivery team exceed a maximum number of patients.…”

Prevalence of amniotomy in Sweden: a nationwide register study

“…The BMI was categorized according to the WHO standards into: underweight (< 18.5), normal (18.5–24.9), overweight (25.0–29.9), obesity Class I (30.0–34.9), obesity Class II (35.0–39.9), and obesity Class III (≥40.0) [ 20 ]. The included hospitals ( n = 38) were categorized into five categories, according to the annual birth volumes or profiles, in order to make a hospital level comparison possible [ 21 ]. Category one included hospitals across the country with annual birth volumes < 1000 ( n = 6).…”

“…Prevalence of amniotomy was calculated for each hospital and then stratified according to the hospitals’ annual number of births. University hospitals were treated as a separate group, independent of the number of births [ 21 ]. For year 2020, prevalence data were only available for January to June.…”

Busy day effect on the use of obstetrical interventions and epidural analgesia during labour: a cross-sectional register study of 601 247 deliveries

“…Our earlier study showed that more blood transfusions were performed during labour during busy days, regardless of the size of the delivery hospital [ 10 ]. It is, therefore, possible that during busy days the delivery hospital’s capacity to offer other obstetrical interventions and epidural analgesia during labour might vary compared to optimal or quiet patient flow days.…”