A ‘busy day’ effect on perinatal complications of delivery on weekends: a retrospective cohort study

Abstract

Objective To evaluate whether busy days on a labour and delivery unit are associated with maternal and neonatal complications of childbirth in California hospitals, accounting for weekday/weekend births. Design This is a population-based retrospective cohort study. Setting Linked vital statistics/patient discharge data for California births between 2009 and 2010 from the Office of Statewide Health Planning and Development. Participants All singleton, cephalic, non-anomalous California births between 2009 and 2010 (N=724 967). Main outcomes The key exposure was high daily obstetric volume, defined as giving birth on a day when the number of births exceeded the hospital-specific 75th percentile of daily delivery volume. Outcomes were a range of maternal and neonatal complications. Results Several maternal and neonatal complications were increased on high-volume days and weekends following adjustment for maternal demographics, annual hospital birth volume and teaching hospital status. For example, compared with low-volume weekdays, the odds of Apgar <7 on low-volume weekend days and high-volume weekend days were 11% (adjusted OR (aOR) 1.11, CI 1.03 to 1.21) and 29% higher (aOR 1.29, CI 1.10 to 1.52), respectively. High volume was associated with increased odds of neonatal seizures on weekdays (aOR 1.33, CI 1.01 to 1.71) and haemorrhage on weekends (aOR 1.11, CI 1.01 to 1.22). After accounting for between-hospital variation, weekend delivery remained significantly associated with increased odds of Apgar score <7, neonatal intensive care unit admission, prolonged maternal length of stay and the odds of neonatal seizures remained increased on high-volume weekdays. Conclusions Our findings suggest that weekend delivery is a consistent risk factor for a range of perinatal complications and there may be variability in how well hospitals handle surges in volume.

Do Time of Birth, Unit Volume and Staff Seniority Affect Neonatal Outcome in Deliveries at ≥34+0 Weeks of Gestation?

“…25,26 This reduced personnel coverage might be a contributor, especially at times with capacity strain during weekday afternoons and weekend days, where labour ward admission volumes are comparable with those of normal office hours. 27,28 Staff seniority has an association with neonatal adverse and severely adverse events, with a higher risk for deliveries attended by senior obstetrical staff; however, the sensitivity graphs (Figure 1 and Figure S3) indicate that this result needs to be interpreted with caution, as staff seniority appears to become protective against adverse events when the odds of pregnancy risks (gamma) exceeds a value of approximately 2.3 for adverse outcome and 6.0 for severely adverse outcome, respectively.…”

“…Future studies might attempt to address this and these results might affect future rotation planning. 28 Snowden et al 27 reported on the effect of fluctuations in admission/patient load and capacity strain, which increased perinatal complication rates during busy days and weekends. Although we believe that this might be an impacting factor, we are unable to adjust our outcome data to labour ward volume and cannot evaluate whether the higher number of adverse and severely adverse events is concentrated on busy afternoons and weekend days.…”

Common challenges managing bed and staff availability on labor and delivery units in the United States: A qualitative analysis

“…Finally, Tenure in role (y) 2 [1][2][3][4][5] Tenure in unit (y) 16 [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] Nurse manager Tenure in role (y) 3 [2][3][4][5][6] Tenure in unit (y) 12 [8][9][10][11][12][13][14][15][16][17][18][19][20] we describe specific effective management practices for addressing each of the challenges we identified based on a framework of proactiveness and systematicness. After describing our study population, we present common management challenges among all the units we analyzed.…”

“…Low financial margins often mean that beds and nursing staff are in limited supply. 13 Bed availability also has been shown to affect clinician decision making, including the likelihood of recommending cesarean deliveries. Throughout health care, insufficient availability of beds and nursing staffing have been associated with higher rates of morbidity and mortality.…”

Clinical Capital and the Risk of Maternal Labor and Delivery Complications: Hospital Scheduling, Timing, and Cohort Turnover Effects

“…Toward the discovery of service inefficiencies, a small number of studies have investigated admission‐timing effects on maternal labor and delivery complications, producing disparate results. Some studies find that complications increase when patients are admitted during weekends and holidays (Bendavid, Kaganova, Needleman, Gruenberg, & Weissman, ; Palmer, Bottle, & Aylin, ; Snowden, Kozhimannil, Muoto, Caughey, & McConnell, ), while other studies find no differences in adverse outcomes between nonelective deliveries occurring during the day, evening, or night (Caughey et al., ), or among Medicaid patients giving birth at teaching hospitals in the month of July (Ford, Bateman, Simpson, & Ratan, ) when a new cohort of residents enter teaching hospitals.…”