Systems Factors in Obstetric Care

Abstract

: II.

Mortality and Treatment Patterns Among Patients Hospitalized With Acute Cardiovascular Conditions During Dates of National Cardiology Meetings

“…Although we found no evidence that total cardiovascular hospitalization volume declined during meeting dates, it is possible that rates of same-day elective procedures and outpatient visits may have declined, which could have the same positive effect on patient outcomes. To our knowledge, no studies exist on the association between daily patient workload and mortality among patients with cardiovascular disease, although in obstetrics, higher-than-predicted daily hospital birth volume has been associated with greater rates of neonatal asphyxia, 25 and in neonatal intensive care, infants admitted to neonatal intensive care units on full- vs half-capacity days have greater mortality. 26 Although all 3 explanations we provide are possible, our data cannot definitively distinguish among these possibilities.…”

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

“…Details of data linkage and quality control are described in detail elsewhere. 11 We obtained human subjects approval from the California OSHPD Committee for the Protection of Human Subjects. The linked data set did not contain potential patient privacy/identification information, so informed consent was exempted.…”

“…11 We defined high daily volume in reference to each hospital’s distribution of daily deliveries. This hospital-specific daily volume distribution was calculated by summing the number of births in that hospital on each day during the study period (2009–2010).…”

“…Most research to date on the weekend effect and busy days have analysed the day of birth as the index day for defining both busy days and weekend births 11, 24 (as compared with the day of maternal hospital admission). However, recent research has considered alternative definition of index day for defining weekend birth, for example, day of birth for neonatal outcomes and day of admission for maternal outcomes.…”

“…In other fields of medicine (eg, emergency medicine 8 and critical care 9 ), fluctuations in admission/patient load have been demonstrated to affect the quality of care. Only a small number of studies have examined perinatal outcomes during times of high volume, 10, 11 and no current evidence addresses maternal outcomes during times of obstetric unit capacity strain in the contemporary US context. This evidence gap is especially pressing, given the increasing prevalence of severe maternal morbidity (eg, postpartum haemorrhage) and maternal death in the USA.…”