Is midwife workload associated with quality of process of care (continuous electronic fetal monitoring [CEFM]) and neonatal outcome indicators? A prospective study in consultant‐led labour wards in Scotland

Abstract

Evidence for staffing recommendations in labour wards is scant. This study aimed to test association between midwife workload with adjusted process of continuous electronic fetal monitoring (CEFM) and neonatal outcome indicators. This was a prospective workload study in 23 consultant-led labour wards in Scotland. There were 3489 livebirths during September 2000, and 1561 consecutively delivered women with CEFM case review during the mid-two weeks. Process measures were: adjusted rates of CEFM, appropriate CEFM, and time to medical response for a serious fetal heart trace abnormality. Neonatal outcome indicators were: Apgar score < 7 at 5 minutes, admission to neonatal unit (NNU) > 48 hours, and neonatal resuscitation. Complete information was available for 99% (2553/2576) of workload time points, 99% (1559) of CEFM process, and 3083 eligible neonates. There were no associations between occupancy or staffing ratios and adjusted CEFM process, Apgar < 7 at 5 minutes (0.98 [0.83, 1.15]) or admission to NNU for > 48 hours (0.97 [0.95, 1.00]). However, there was association between increasing staffing ratios and lower odds of adjusted neonatal resuscitation (excluding bag and mask only) (0.97 [0.94, 0.99]). The direction of effect of increasing workload suggests detriment to outcome indicators, although the size of effect may be small.

The Association Between Hospital Capacity Strain and Inpatient Outcomes in Highly Developed Countries: A Systematic Review

“…[11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][32][33][34][35][36][37][38][39][40][41][42][43]48,49,53 All observational studies were cohort studies; all but four were retrospective. 32,42,43,46 Eight studies described interventions to improve care during times of capacity strain, [55][56][57][58][59][60][61][62] none using randomization to assign treatment category. Outcomes for children were separately analyzed in only six of the observational studies 23,26,32,45,46,51 and none of the experimental studies.…”

“…32,42,43,46 Eight studies described interventions to improve care during times of capacity strain, [55][56][57][58][59][60][61][62] none using randomization to assign treatment category. Outcomes for children were separately analyzed in only six of the observational studies 23,26,32,45,46,51 and none of the experimental studies. Characteristics of included studies are described in the Online Appendix.…”

Staff workload and adverse events during mechanical ventilation in neonatal intensive care units

“…Uma das maiores diferenças entre países desenvolvidos e em desenvolvimento talvez seja o número médio de recém-nascidos por enfermeiro ou auxiliar de enfermagem. No Brasil, algumas unidades chegam a apresentar níveis médios da ordem de 2,86 pacientes por auxiliar de enfermagem 17 , enquanto países desenvolvidos como o Reino Unido costumam apresentar níveis médios da ordem de 0,84 enfermeiro equivalente a tempo integral (ETI) por paciente (1,19 paciente por enfermeiro ETI) 23 e 0,84-1,0 enfermeiro por paciente (1,0-1,19 paciente por enfermeiro) 6 . Marcin et al 12 observaram que uma proporção enfermeiro-paciente da ordem de 1:2 aumentou o risco de uma extubação acidental.…”

“…Tibby et al 22 também encontraram uma associação semelhante em uma UTIN pediátrica em Londres. Estudos realizados por Hamilton et al 3 , Tarnow-Mordi et al 4 , Tucker & the UK Neonatal Staffing Study Group 6 e Tucker et al 23 parecem indicar que uma carga de trabalho maior está associada a um aumento na ocorrência de desfechos clínicos desfavoráveis relacionados à ventilação mecânica.…”

Doğumhanede Çalışan Ebeler İçin İşyükü Analizine Dayalı İnsangücü Planlaması

“…Ebelik hizmeti veren sağlık çalışanlarının doğumhaneler için iş yükleri, yıllık hasta hacimleri, vaka karışımları ve ça-lışanlar ele alınarak yapılacak kurumlar arası karşılaştırma-lar ya da hasta sayılarının ve onlarla ilişkili iş yüklerinin devamlı gözlenmesi ve gözlem sayıları ile çalışanların beceri seviyelerinin karşılaştırılması ile belirlenebilir (12).…”