Determining obstetric patient safety indicators: the differences in neonatal outcome measures between different‐sized delivery units

Abstract

Objective To study the differences in neonatal outcome and treatment measures in Finnish obstetric units.Design A registry study with Medical Birth Register data.Setting and population All births (n = 2 94 726) in Finland from 2006 to 2010 with a focus on term, singleton non-university deliveries.Methods All 34 delivery units were grouped into small (below 1000), mid-sized (1000-2999) and large (3000 or more) units, and the adverse outcome rates in neonates were compared using logistic regression.Main outcome measures Early neonatal deaths, stillbirths, Apgar scores, arterial cord pH, Erb's paralysis, respirator treatment, the proportion of post-term deliveries (gestational age beyond 42 weeks) and the proportion of newborns still hospitalised 7 days after delivery.Results From an analysis of term, singleton non-university deliveries, the early neonatal mortality was significantly higher in the small relative to the mid-sized delivery units [odds ratio (OR), 2.07; 95% confidence interval (CI), 1.19-3.60]. The rate of Erb's paralysis was lowest in the large units (OR, 0.65; 95% CI, 0.50-0.84). The use of a respirator was more than two-fold more common in large relative to mid-sized units (OR, 2.38; 95% CI, 2.00-2.83). The proportion of post-term deliveries was highest in the large units (OR, 1.36; 95% CI, 1.31-1.42), where a significantly higher percentage of post-term newborns were still hospitalised after 7 days (OR, 1.50; 95% CI, 1.19-1.89).Conclusions There are significant differences in several neonatal indicators dependent on the hospital size. An international consensus is needed on which indicators should be used.

Effect of hospital size and on-call arrangements on intrapartum and early neonatal mortality among low-risk newborns in Finland

“…In our study, Apgar scores and umbilical pH values did not reveal differences in care during delivery. This is in line with previous studies in determining obstetric patient safety indicators, suggesting more national and international projects for creating international consensus on quality indicators [16,17]. Newborn outcomes should not be worse in smaller non-university hospitals, since high-risk pregnancies are systematically directed to a higher-level hospital for obstetric care and delivery.…”

Neue Volume-Outcome-Ergebnisse in der Perinatalmedizin

“…Von insgesamt 6.464 Treffern der Literaturrecherche wurden nach einem mehrstufigen Auswahlprozess schließlich 11 relevante Artikel zur Forschungsfrage identifiziert und analysiert. Die eingeschlossenen Studien stammen aus Finnland (Karalis et al 2016;Pyykönen et al 2014;Hemminki et al 2011) den USA (Friedman et al 2016;Snowden et al 2012), Deutschland (Heller et al 2002;Heller et al 2003), Australien (Tracy et al 2006), Norwegen (Moster et al 2001), Großbritannien (Joyce et al 2004) und Schweden (Finnström et al 2006). Die Daten sind zumeist nationalen Geburtsregistern entnommen.…”

“…Die Studien der nordischen Länder und die australische Studie beziehen jeweils landesweite Daten der nationalen Geburtsregister ein, mit Selektierungen bezüglich des Ausschlusses von Mehrlingsgeburten (Finnström et al 2006), Risikogeburten (Karalis et al 2016) und nicht termingerechten Geburten bzw. Geburten in Universitätskliniken (Pyykönen et al 2014 (Karalis et al 2016;Pyykönen et al 2014;Heller et al 2002Heller et al und 2003 berichteten zu früher neonataler Sterblichkeit. Sieben Studien (Finnström et al 2006;Moster et al 2001;Pyykönen et al 2014;Snowden et al 2012;Tracy et al 2006;Heller et al 2003und Joyce et al 2004 analysierten neonatale Sterblichkeit.…”

“…Geburten in Universitätskliniken (Pyykönen et al 2014 (Karalis et al 2016;Pyykönen et al 2014;Heller et al 2002Heller et al und 2003 berichteten zu früher neonataler Sterblichkeit. Sieben Studien (Finnström et al 2006;Moster et al 2001;Pyykönen et al 2014;Snowden et al 2012;Tracy et al 2006;Heller et al 2003und Joyce et al 2004 analysierten neonatale Sterblichkeit. Zwei Studien (Pyykönen et al 2014und Hemminki et al 2011) berichten zu perinataler Sterblichkeit.…”

A step‐wise approach to developing indicators to compare the performance of maternity units using hospital administrative data

“…This may be static reports, interactive online formats, and/or a series of local or regional discussion meetings. Finally, it is important to encourage those who use indicators not to interpret the results of individual indicators in isolation, but to look at a suite as a whole, considering possible relationships between indicators . For example, in maternity care there is an association between lower prelabour caesarean section rates and therefore higher vaginal delivery rates on the one hand but also higher emergency caesarean section rates, which in turn can influence outcomes such as length of stay or readmission post‐delivery.…”