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

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Vilkko , R , Räisänen , S , Gissler , M , Stefanovic , V , Kalliala , I & Heinonen , S 2022 , ' Busy day effect on the use of obstetrical interventions and epidural analgesia during labour : a cross-sectional register study of 601 247 deliveries ' , BMC Pregnancy and Childbirth , vol. 22 , no. 1 , 481 . https://doi.org/10.1186/s12884-022-04798-6

Title: Busy day effect on the use of obstetrical interventions and epidural analgesia during labour : a cross-sectional register study of 601 247 deliveries
Author: Vilkko, Riitta; Räisänen, Sari; Gissler, Mika; Stefanovic, Vedran; Kalliala, Ilkka; Heinonen, Seppo
Contributor organization: Doctoral Programme in Clinical Research
Clinicum
University of Helsinki
Faculty of Medicine
Department of Obstetrics and Gynecology
HUS Gynecology and Obstetrics
Date: 2022-06-13
Language: eng
Number of pages: 9
Belongs to series: BMC Pregnancy and Childbirth
ISSN: 1471-2393
DOI: https://doi.org/10.1186/s12884-022-04798-6
URI: http://hdl.handle.net/10138/346288
Abstract: Background Daily delivery volume might affect the quality of obstetric care. We explored the busy day effect on selected obstetrical interventions and epidural analgesia performed during labour in different sized delivery hospitals and on the Finnish obstetric ecosystem. Methods We conducted a cross-sectional study on Finnish Medical Birth Register data of singleton pregnancies (N = 601,247) from 26 delivery hospitals from 2006 to 2016. Delivery hospitals were stratified by annual delivery volume: C (category) 1: < 1000, C2: 1000-1999, C3: 2000-2999, C4: >= 3000, and C5: university hospitals. The exposure variables were defined as quiet, optimal, and busy days determined based on daily delivery volume distribution in each hospital category. Quiet and busy days included approximately 10% of the lowest and highest delivery volume days, while the rest were defined as optimal. Outcome measures were unplanned caesarean section (CS), instrumental delivery, induction of labour, and epidural analgesia. We compared the incidence of outcomes in quiet vs. optimal, busy vs. optimal, and busy vs. quiet days using logistic regression. The statistical significance level was set at 99% to reduce the likelihood of significant spurious findings. Results In the total population, the incidence of instrumental delivery was 8% (99% CI 2-15%) lower on quiet than on optimal days. In smaller hospitals (C1 and C2), unplanned caesarean sections were performed up to one-third less frequently on busy than optimal and quiet days. More (27%, 99% CI 12-44%) instrumental deliveries were performed in higher delivery volume hospitals (C4) on busy than quiet days. In C1-C3, deliveries were induced (12-35%) less often and in C5 (37%, 99% CI 28-45%) more often on busy than optimal delivery days. More (59-61%) epidural analgesia was performed on busy than optimal and quiet days in C4 and 8% less in C2 hospitals. Conclusions Pooled analysis showed that busyness had no effect on outcomes at the obstetric ecosystem level, but 10% fewer instrumental deliveries were performed in quiet than on busy days overall. Furthermore, dissecting the data shows that small hospitals perform less, and large non-tertiary hospitals perform more interventions during busy days.
Subject: Busy day effect
Delivery volume
Hospital size
Intervention during labour
Obstetrics
Obstetrical intervention
Register study
MATERNAL DEATH
PATIENT FLOW
QUALITY
SAFETY
CARE
3123 Gynaecology and paediatrics
Peer reviewed: Yes
Rights: cc_by
Usage restriction: openAccess
Self-archived version: publishedVersion


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