1
|
Shukla VV, Carlo WA. Risk Prediction for Stillbirth and Neonatal Mortality in Low-resource Settings. NEWBORN (CLARKSVILLE, MD.) 2022; 1:215-218. [PMID: 36540873 PMCID: PMC9762612 DOI: 10.5005/jp-journals-11002-0034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
High stillbirth and neonatal mortality are major public health problems, particularly in low-resource settings in low- and middle-income countries (LMIC). Despite sustained efforts by national and international organizations over the last several decades, quality intrapartum and neonatal care is not universally available, especially in these low-resource settings. A few studies identify risk factors for adverse perinatal outcomes in low-resource settings in LMICs. This review highlights the evidence of risk prediction for stillbirth and neonatal death. Evidence using advanced machine-learning statistical models built on data from low-resource settings in LMICs suggests that the predictive accuracy for intrapartum stillbirth and neonatal mortality using prenatal and pre-delivery data is low. Models with delivery and post-delivery data have good predictive accuracy of the risk for neonatal mortality. Birth weight is the most important predictor of neonatal mortality. Further validation and testing of the models in other low-resource settings and subsequent development and testing of possible interventions could advance the field.
Collapse
Affiliation(s)
- Vivek V Shukla
- Division of Neonatology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Waldemar A Carlo
- Division of Neonatology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| |
Collapse
|
2
|
Turner L, Griffiths P, Kitson-Reynolds E. Midwifery and nurse staffing of inpatient maternity services - A systematic scoping review of associations with outcomes and quality of care. Midwifery 2021; 103:103118. [PMID: 34428733 DOI: 10.1016/j.midw.2021.103118] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 05/25/2021] [Accepted: 07/29/2021] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To undertake a scoping literature review of studies examining the quantitative association between staffing levels and outcomes for mothers, neonates, and staff. The purpose was to understand the strength of the available evidence, the direction of effects, and to highlight gaps for future research. DATA SOURCES Systematic searches were conducted in Medline (Ovid), Embase (Ovid), CINAHL (EBCSCO), Cochrane Library, TRIP, Web of Science and Scopus. STUDY SELECTION AND REVIEW METHODS To be eligible, staffing levels had to be quantified for in-patient settings, such as ante-natal, labour/delivery or post-natal care. Staff groups included midwives, nurse midwives or equivalent, and assistant staff working under the supervision of professionals. Studies of the quality of care, patient outcomes and staff outcomes were included from all countries. All quantitative designs were included, including controlled trials, time series, cross-sectional, cohort studies and case controlled studies. Data were extracted and sources of bias identified by considering the study design, measurement of exposure and outcomes, and risk adjustment. Studies were grouped by outcome noting the direction and significance of effects. RESULTS The search yielded a total of 3280 records and 21 studies were included in this review originating from ten countries. There were three randomised controlled trials, eleven cohort studies, one case control study and six cross sectional studies. Seventeen were multicentre studies and nine of them had over 30,000 participants. Reduced incidence of epidural use, augmentation, perineal damage at birth, postpartum haemorrhage, maternal readmission, and neonatal resuscitation were associated with increased midwifery staff. Few studies have suggested a negative impact of increasing staffing rates, although a number of studies have found no significant differences in outcomes. Impact on the mode of birth was unclear. Increasing midwifery assistants was not associated with improved patient outcomes. No studies were found on the impact of low staffing levels for the midwifery workforce. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Although there is some evidence that higher midwifery staffing is associated with improved outcomes, current research is insufficient to inform service planning. Studies mainly reported outcomes relating to labour, highlighting a gap in research evidence for the antenatal and postnatal periods. Further studies are needed to assess the costs and consequences of variations in maternity staffing, including the deployment of maternity assistants and other staff groups.
Collapse
Affiliation(s)
- Lesley Turner
- School of Health Sciences, University of Southampton, Highfield Campus, Southampton SO17 1BJ,.
| | - Peter Griffiths
- School of Health Sciences, University of Southampton, Highfield Campus, Southampton SO17 1BJ and National Institute for Health Research Applied Research Centre (Wessex).
| | - Ellen Kitson-Reynolds
- School of Health Sciences, University of Southampton, Highfield Campus, Southampton SO17 1BJ,.
| |
Collapse
|
3
|
Walther F, Kuester D, Bieber A, Malzahn J, Rüdiger M, Schmitt J. Are birth outcomes in low risk birth cohorts related to hospital birth volumes? A systematic review. BMC Pregnancy Childbirth 2021; 21:531. [PMID: 34315416 PMCID: PMC8314545 DOI: 10.1186/s12884-021-03988-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 07/02/2021] [Indexed: 01/08/2023] Open
Abstract
Background There is convincing evidence that birth in hospitals with high birth volumes increases the chance of healthy survival in high-risk infants. However, it is unclear whether this is true also for low risk infants. The aim of this systematic review was to analyze effects of hospital’s birth volume on mortality, mode of delivery, readmissions, complications and subsequent developmental delays in all births or predefined low risk birth cohorts. The search strategy included EMBASE and Medline supplemented by citing and cited literature of included studies and expert panel highlighting additional literature, published between January/2000 and February/2020. We included studies which were published in English or German language reporting effects of birth volumes on mortality in term or all births in countries with neonatal mortality < 5/1000. We undertook a double-independent title-abstract- and full-text screening and extraction of study characteristics, critical appraisal and outcomes in a qualitative evidence synthesis. Results 13 retrospective studies with mostly acceptable quality were included. Heterogeneous volume-thresholds, risk adjustments, outcomes and populations hindered a meta-analysis. Qualitatively, four of six studies reported significantly higher perinatal mortality in lower birth volume hospitals. Volume-outcome effects on neonatal mortality (n = 7), stillbirths (n = 3), maternal mortality (n = 1), caesarean sections (n = 2), maternal (n = 1) and neonatal complications (n = 1) were inconclusive. Conclusion Analyzed studies indicate higher rates of perinatal mortality for low risk birth in hospitals with low birth volumes. Due to heterogeneity of studies, data synthesis was complicated and a meta-analysis was not possible. Therefore international core outcome sets should be defined and implemented in perinatal registries. Systematic review registration PROSPERO: CRD42018095289 Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-03988-y.
Collapse
Affiliation(s)
- Felix Walther
- Center for Evidence-Based Healthcare, Medical Faculty Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307, Dresden, Germany. .,Quality and Medical Risk Management, University Hospital Carl, Gustav Carus, Fetscherstraße 74, 01307, Dresden, Germany.
| | - Denise Kuester
- Center for Evidence-Based Healthcare, Medical Faculty Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Anja Bieber
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Postfach 302, 06097, Halle, Saale, Germany
| | - Jürgen Malzahn
- Federation of Local Health Insurance Funds, Clinical Care, Rosenthaler Str. 31, 10178, Berlin, Germany
| | - Mario Rüdiger
- Department for Neonatology and Pediatric Intensive Care, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany.,Medical Faculty Carl Gustav Carus, Saxony Center for Feto-Neonatal Health, TU Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Jochen Schmitt
- Center for Evidence-Based Healthcare, Medical Faculty Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307, Dresden, Germany.,Medical Faculty Carl Gustav Carus, Saxony Center for Feto-Neonatal Health, TU Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| |
Collapse
|
4
|
Reif P, Pichler G, Griesbacher A, Lehner G, Schöll W, Lang U, Hofmann H, Ulrich D. Do time of birth, unit volume, and staff seniority affect neonatal outcome in deliveries at ≥34
+0
weeks of gestation? BJOG 2017; 125:884-891. [DOI: 10.1111/1471-0528.15000] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2017] [Indexed: 11/27/2022]
Affiliation(s)
- P Reif
- Department of Obstetrics and Gynaecology Medical University of Graz Graz Austria
| | - G Pichler
- Division of Neonatology Department of Paediatrics Medical University of Graz Graz Austria
| | - A Griesbacher
- Risk Assessment, Data and Statistics Austrian Agency for Health and Food Safety Graz Austria
| | - G Lehner
- Department of Obstetrics and Gynaecology Medical University of Graz Graz Austria
| | - W Schöll
- Department of Obstetrics and Gynaecology Medical University of Graz Graz Austria
| | - U Lang
- Department of Obstetrics and Gynaecology Medical University of Graz Graz Austria
| | - H Hofmann
- Department of Obstetrics and Gynaecology Hospital Feldbach Feldbach Austria
| | - D Ulrich
- Department of Obstetrics and Gynaecology Medical University of Graz Graz Austria
| |
Collapse
|
5
|
Adams N, Tudehope D, Gibbons KS, Flenady V. Perinatal mortality disparities between public care and private obstetrician-led care: a propensity score analysis. BJOG 2017; 125:149-158. [DOI: 10.1111/1471-0528.14903] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2017] [Indexed: 11/29/2022]
Affiliation(s)
- N Adams
- Mater Research Institute; University of Queensland; South Brisbane QLD Australia
| | - D Tudehope
- Mater Research Institute; University of Queensland; South Brisbane QLD Australia
- The School of Medicine; The University of Queensland; Brisbane QLD Australia
| | - KS Gibbons
- Mater Research Institute; University of Queensland; South Brisbane QLD Australia
| | - V Flenady
- Mater Research Institute; University of Queensland; South Brisbane QLD Australia
- The School of Medicine; The University of Queensland; Brisbane QLD Australia
| |
Collapse
|
6
|
Imison C, Sonola L, Honeyman M, Ross S, Edwards N. Insights from the clinical assurance of service reconfiguration in the NHS: the drivers of reconfiguration and the evidence that underpins it – a mixed-methods study. HEALTH SERVICES AND DELIVERY RESEARCH 2015. [DOI: 10.3310/hsdr03090] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundOver the life of the NHS, hospital services have been subject to continued reconfiguration. Yet it is rare for the reconfiguration of clinical services to be evaluated, leaving a deficit in the evidence to guide local reconfiguration of services.ObjectivesThe objectives of this research are to determine the current pressures for reconfiguration within the NHS in England and the solutions proposed. We also investigate the quality of evidence used in making the case for change, any key evidence gaps, and the opportunities to strengthen the clinical case for change and how it is made.MethodsWe have drawn on two key sources of evidence. First, we reviewed the reports produced by the National Clinical Advisory Team (NCAT) documenting its reviews of reconfiguration proposals. An in-depth multilevel qualitative analysis was conducted of 123 NCAT reviews published between 2007 and 2012. Second, we carried out a search and synthesis of the literature to identify the key evidence available to support reconfiguration decisions. The findings from this literature search were integrated with the analysis of the reviews to develop a narrative for each specialty and the process of reconfiguration as a whole.ResultsThe evidence from the NCAT reviews shows significant pressure to reconfigure services within the NHS in England. We found that the majority of reconfiguration proposals are driving an increasing concentration of hospital services, with some accompanying decentralisation and, for some specialist services, the development of supporting clinical networks. The primary drivers of reconfiguration have been workforce (in particular the medical workforce) and finance. Improving outcomes and safety issues have been subsidiary drivers, though many make the link between staffing and clinical safety. Policy has also been a notable driver. Access has been notable by its absence as a driver. Despite significant pressures to reconfigure services, many proposals fail to be implemented owing to public and/or clinical opposition. We found strong evidence that some specialist service reconfiguration including vascular surgery and major trauma can significantly improve clinical outcomes. However, there are notable evidence gaps. The most significant is the absence of evidence that service reconfiguration can deliver significant savings. There is also an absence of evidence about safe staffing models and the interplay between staff numbers, skill mix and outcomes. We found that the advice provided by the NCAT reflects the current evidence, but one of the NCAT’s most valuable contributions has been to encourage greater clinical engagement in service change.ConclusionsThe NHS is continuing to concentrate many district general hospital services to resolve financial and workforce pressures. However, many proposals are not implemented owing to public opposition. We also found no evidence to suggest that this will deliver the savings anticipated. There is a significant gap in the evidence about safe staffing models and the appropriate balance of junior and senior medical as well as other clinical staff. There is an urgent need to carry out research that will help to fill the current evidence gap. There is also a need to retain some national clinical expertise to work alongside Clinical Senates in supporting local service reconfiguration.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
Collapse
Affiliation(s)
| | - Lara Sonola
- Policy Directorate, The King’s Fund, London, UK
| | | | - Shilpa Ross
- Policy Directorate, The King’s Fund, London, UK
| | | |
Collapse
|
7
|
Milland M, Mikkelsen KL, Christoffersen JK, Hedegaard M. Severe and fatal obstetric injury claims in relation to labor unit volume. Acta Obstet Gynecol Scand 2015; 94:534-41. [DOI: 10.1111/aogs.12606] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 01/29/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Maria Milland
- Department of Obstetrics; Rigshospitalet Copenhagen University Hospital; Copenhagen Denmark
| | | | | | - Morten Hedegaard
- Department of Obstetrics; Rigshospitalet Copenhagen University Hospital; Copenhagen Denmark
| |
Collapse
|
8
|
Sandall J, Murrells T, Dodwell M, Gibson R, Bewley S, Coxon K, Bick D, Cookson G, Warwick C, Hamilton-Fairley D. The efficient use of the maternity workforce and the implications for safety and quality in maternity care: a population-based, cross-sectional study. HEALTH SERVICES AND DELIVERY RESEARCH 2014. [DOI: 10.3310/hsdr02380] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundThe performance of maternity services is seen as a touchstone of whether or not we are delivering high-quality NHS care. Staffing has been identified in numerous reports as being a critical component of safe, effective, user-centred care. There is little evidence regarding the impact of maternity workforce staffing and skill mix on the safety, quality and cost of maternity care in the UK.ObjectivesTo understand the relationship between organisational factors, maternity workforce staffing and skill mix, cost and indicators of safe and high-quality care.Design and methodsData included Hospital Episode Statistics (HES) from 143 NHS trusts in England in 2010–11 (656,969 delivery records), NHS Workforce Statistics, England, 2010–11, Care Quality Commission Maternity Survey of women’s experiences 2010 and NHS reference costs 2010/11. Ten indicators were derived from HES data. They included healthy mother and healthy baby outcomes and mode of birth. Adjustments were made for background characteristics and clinical risk. Data were analysed to examine the influence of organisational factors, staffing and costs using multilevel logistic regression models. A production function analysis examined the relationship between staffing, skill mix and output.ResultsOutcomes were largely determined by women’s level of clinical risk [based on National Institute for Health and Care Excellence (NICE) guidance], parity and age. The effects of trust size and trust university status were small. Larger trust size reduced the chance of a healthy mother outcome and also reduced the likelihood of a healthy mother/healthy baby dyad outcome, and increased the chances of other childbirth interventions. Increased investment in staff did not necessarily have an effect on the outcome and experience measures chosen, although there was a higher rate of intact perineum and also of delivery with bodily integrity in trusts with greater levels of midwifery staffing. An analysis of the multiplicative effects of parity and clinical risk with the staffing variables was more revealing. Increasing the number of doctors had the greatest impact on outcomes in higher-risk women and increasing the number of midwives had the greatest impact on outcomes in lower-risk women. Although increased numbers of support workers impacted on reducing childbirth interventions in lower-risk women, they also had a negative impact on the healthy mother/healthy baby dyad outcomes in all women. In terms of maximising the capacity of a trust to deliver babies, midwives and support workers were found to be substitutes for each other, as were consultants and other doctors. However, any substitution between staff groups could impact on the quality of care given. Economically speaking, midwives are best used in combination with consultants and other doctors.ConclusionsStaffing levels have positive and negative effects on some outcomes, and deployment of doctors and midwives where they have most beneficial impact is important. Managers may wish to exercise caution in increasing the number of support workers who care for higher-risk women. There also appear to be limited opportunities for role substitution.Future workWide variations in outcomes remain after adjustment for sociodemographic and clinical risk, and organisational factors. Further research is required on what may be influencing unexplained variation such as organisational climate and culture, use of NICE guidelines in practice, variation of models of care within trusts and women’s choices.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
Collapse
Affiliation(s)
- Jane Sandall
- Women’s Health Academic Centre (King’s Health Partners), Division of Women’s Health, King’s College London, London, UK
| | - Trevor Murrells
- Florence Nightingale Faculty of Nursing and Midwifery, King’s College London, London, UK
| | - Miranda Dodwell
- Women’s Health Academic Centre (King’s Health Partners), Division of Women’s Health, King’s College London, London, UK
- BirthChoiceUK, London, UK
| | - Rod Gibson
- Women’s Health Academic Centre (King’s Health Partners), Division of Women’s Health, King’s College London, London, UK
- BirthChoiceUK, London, UK
| | - Susan Bewley
- Women’s Health Academic Centre (King’s Health Partners), Division of Women’s Health, King’s College London, London, UK
| | - Kirstie Coxon
- Women’s Health Academic Centre (King’s Health Partners), Division of Women’s Health, King’s College London, London, UK
| | - Debra Bick
- Florence Nightingale Faculty of Nursing and Midwifery, King’s College London, London, UK
| | - Graham Cookson
- Department of Management, King’s College London, London, UK
- Department of Health Care Management and Policy, University of Surrey, Guildford, Surrey, UK
| | | | - Diana Hamilton-Fairley
- Guy’s and St Thomas’ NHS Foundation Trust, London, UK
- Health Education South London, London, UK
| |
Collapse
|
9
|
Chiabi A, Takou V, Mah E, Nguefack S, Siyou H, Takou V, Tchokoteu PF, Mbonda E. Risk factors for neonatal mortality at the yaounde gynaeco-obstetric and pediatric hospital, cameroon. IRANIAN JOURNAL OF PEDIATRICS 2014; 24:393-400. [PMID: 25755860 PMCID: PMC4339562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 03/25/2014] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Neonatal mortality is a major health problem in sub-Saharan Africa and the risk factors are not well established. The objective of this study was to determine the risk factors for neonatal mortality at the Yaounde Gynaeco-Obstetric and Pediatric Hospital. METHODS We conducted a retrospective and analytic case-control study from the medical records of newborns admitted at the neonatal unit of this hospital between 1(st) March 2003 and 31(st) December 2012. 850 subjects were enrolled; that is 425 cases and 425 controls. Findings : The intra-hospital neonatal mortality rate was 9.83%. The main causes of neonatal mortality were in descending order: neonatal sepsis (60.2%), complications from prematurity (42.6%), birth asphyxia (37.4%), and congenital malformations (11.8%).The most prominent risk factors for neonatal mortality after multivariate analysis with logistic regression were: prolonged membrane rupture (OR: 3.8719, 95% CI: 2.3619-6.3471; P=0.0000), low birth weight (OR: 1.6240, 95% CI: 1.0108-2.6091; P=0.0450), Apgar score less than 7 at the 5th minute (OR: 6.8979, 95% CI: 4.0709-11.6883; P=0.0000), and congenital malformations (OR: 4.3307, 95% CI: 1.6120-11.6347; P=0.0037). Delivery by cesarean section (OR: 0.2644, 95% CI: 0.1478-0.4732; P=0.0000) and being born in this hospital (OR: 0.4409;95% CI: 0.2566-0.7576; P=0.0030) were protective. CONCLUSION Neonatal mortality was influenced by both maternal and neonatal factors. This could be reduced through sensitization of pregnant women on the need of good quality antenatal visits, and capacitating the health personnel on the adequate management of high risk neonates.
Collapse
Affiliation(s)
- Andreas Chiabi
- Yaounde Gynaeco-Obstetric and Pediatric Hospital, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Cameroon
| | | | | | | | | | | | | | | |
Collapse
|
10
|
Carlsen F, Grytten J, Eskild A. Maternal education and risk of offspring death; changing patterns from 16 weeks of gestation until one year after birth. Eur J Public Health 2013; 24:157-62. [PMID: 23782981 DOI: 10.1093/eurpub/ckt065] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The social disparity in perinatal mortality may vary by the age of the offspring. We studied offspring mortality from pregnancy week 16 until 1 year after birth by maternal educational level. METHODS We included all births in Norwegian women during the years 1999-2004 (n = 297 663). The Medical Birth Registry of Norway was linked to the Norwegian Education Registry to obtain individual information on maternal education at the time of delivery. Information on infant mortality was obtained by linkage to the Norwegian Central Person Registry. RESULTS In pregnancy weeks 37 through 43 and in the first week after birth, there was little difference in offspring mortality by maternal education. Before pregnancy week 37, the excess offspring mortality associated with compulsory school only was >60% using university/college education as the reference. During the 2nd through 12th month after birth, the excess mortality was 132% in offspring of mothers with compulsory school only. CONCLUSION The social disparity in offspring mortality was lowest in pregnancies at term and in the first week after birth. In this period, all women living in Norway and their infants use the public health care service extensively. Our results may suggest that health care that is equally available to all citizens, reduces social disparities in mortality.
Collapse
Affiliation(s)
- Fredrik Carlsen
- 1 Department of Economics, Norwegian University of Science and Technology, Trondheim, Norway
| | | | | |
Collapse
|
11
|
Abstract
Global recognition is increasing of the contribution of midwifery services to optimal outcomes for women and babies, and evidence around how to organize services and the roles of maternity providers. However, a sociological analysis can provide some insight into why the role of midwives varies so widely in different countries. Evidence is necessary, but more important is the role of the state in legalizing and financially supporting midwifery practice, how professional boundaries are negotiated in the maternity care domain, and consumer mobilization in support of midwifery and around maternity issues.
Collapse
Affiliation(s)
- Jane Sandall
- Social Science and Women's Health, Research Division of Women's Health, King's College London, London, United Kingdom
| |
Collapse
|
12
|
Brown KL, Pagel C, Pienaar A, Utley M. The relationship between workload and medical staffing levels in a paediatric cardiac intensive care unit. Intensive Care Med 2010; 37:326-33. [PMID: 21125216 DOI: 10.1007/s00134-010-2085-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2009] [Accepted: 06/16/2010] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the matching between workload in a paediatric cardiac intensive care unit (ICU) and the corresponding medical staffing levels over a 24-h period. DESIGN A review of workload measured by: (a) admissions, (b) severity of illness in admissions using case-mix descriptors and mortality as a proxy, (c) cardiac arrests (CA) and (d) extracorporeal membrane oxygenation (ECMO) cannulations. An evaluation of matching between workload and medical staff schedules. SETTING A tertiary paediatric cardiac ICU. PATIENTS 2,799 admissions over a 49-month period. RESULTS New admissions peaked in the evening, and the ratio of doctors' hours to admissions was lowest between 1359 and 2000 h. Although only 515 (17.3%) cases were admitted between 2000 and 0759 h, these were more likely to be emergencies, to have higher Paediatric Index of Mortality 2 (PIM2) scores and to die (p < 0.001). There was an increased adjusted risk of death in admissions between 2000 and 0159 h (p = 0.021). There was no difference in the occurrence of either CA (p = 0.41) or ECMO (p = 0.95) between day and night. The ratio of doctors' hours to CAs and ECMOs was lowest from 2000 to 0800 h. The conventional medical staffing roster generated the greatest concentration of staff in the morning, reducing to the lowest level between 0200 and 0759 h. CONCLUSIONS Workload was most intense for the in-house team at night, in terms of sicker admissions, ECMOs and cardiac arrests. Conventional roster patterns may not offer ideal matching between staffing and workload. Data analysis of variable and urgent workload may be used to inform medical rosters.
Collapse
Affiliation(s)
- Katherine L Brown
- Cardiac Unit, Great Ormond Street Hospital NHS Trust, London WC1N 3JH, UK.
| | | | | | | |
Collapse
|
13
|
de Graaf JP, Ravelli ACJ, Visser GHA, Hukkelhoven C, Tong WH, Bonsel GJ, Steegers EAP. Increased adverse perinatal outcome of hospital delivery at night. BJOG 2010; 117:1098-107. [PMID: 20497413 DOI: 10.1111/j.1471-0528.2010.02611.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine whether delivery in the evening or at night and some organisational features of maternity units are related to perinatal adverse outcome. DESIGN A 7-year national registry-based cohort study. SETTING All 99 Dutch hospitals. POPULATION From nontertiary hospitals (n = 88), 655 961 singleton deliveries from 32 gestational weeks onwards, and, from tertiary centres (n = 10), 108 445 singleton deliveries from 22 gestational weeks onwards. METHODS Multiple logistic regression analysis of national perinatal registration data over the period 2000-2006. In addition, multilevel analysis was applied to investigate whether the effects of time of delivery and other variables systematically vary across different hospitals. MAIN OUTCOME MEASURES Delivery-related perinatal mortality (intrapartum or early neonatal mortality) and combined delivery-related perinatal adverse outcome (any of the following: intrapartum or early neonatal mortality, 5-minute Apgar score below 7, or admission to neonatal intensive care). RESULTS After case mix adjustment, relative to daytime, increased perinatal mortality was found in nontertiary hospitals during the evening (OR, 1.32; 95% CI, 1.15-1.52) and at night (OR, 1.47; 95% CI, 1.28-1.69) and, in tertiary centres, at night only (OR, 1.20; 95% CI, 1.06-1.37). Similar significant effects were observed using the combined perinatal adverse outcome measure. Multilevel analysis was unsuccessful; extending the initial analysis with nominal hospital effects and hospital-delivery time interaction effects confirmed the significant effect of night in nontertiary hospitals, whereas other organisational effects (nontertiary, tertiary) were taken up by the hospital terms. CONCLUSION Hospital deliveries at night are associated with increased perinatal mortality and adverse perinatal outcome. The time of delivery and other organisational features representing experience (seniority of staff, volume) explain hospital-to-hospital variation.
Collapse
Affiliation(s)
- J P de Graaf
- Division of Obstetrics and Prenatal Medicine, Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | | | | | | | | | | | | |
Collapse
|
14
|
BATTIN MR, McCOWAN LME, GEORGE-HADDAD M, THOMPSON JMD. Fetal growth restriction and other factors associated with neonatal death in New Zealand. Aust N Z J Obstet Gynaecol 2007; 47:457-63. [DOI: 10.1111/j.1479-828x.2007.00779.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
15
|
Badr LK, Abdallah B, Balian S, Tamim H, Hawari M. The chasm in neonatal outcomes in relation to time of birth in Lebanon. Neonatal Netw 2007; 26:97-102. [PMID: 17402601 DOI: 10.1891/0730-0832.26.2.97] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
PURPOSE The purpose of this study was to investigate the relationship between the time of birth and the mortality and morbidity of infants admitted to neonatal intensive care units. DESIGN This prospective, cohort study examined the records of women and infants admitted to the NICUs of four hospitals in Beirut, Lebanon, between July 1, 2002, and June 30, 2003. The hospitals selected were university affiliated and had a large number of deliveries (5,152 total for the year 2002-2003). MAIN OUTCOME VARIABLES Neonatal mortality and morbidity for infants admitted to the NICU were evaluated in relation to time of birth. RESULTS For the whole sample, mortality was higher for infants born during the night shift than for those born during the day shift. Mortality, morbidity, and brain asphyxia rates were also higher for infants born during the night shift and admitted to the NICU. Maternal risk factors and delivery complications were nor consistently higher on the night shift.
Collapse
|
16
|
Abstract
OBJECTIVE To estimate what level of additional fetal risk women and their caregivers in late pregnancy considered acceptable to avoid a cesarean and achieve a vaginal birth. METHODS Six hundred women in late pregnancy and 294 obstetric consultants, registrars, midwives, and medical students were recruited to the study. With the assistance of a visual probability aid representing 10,000 births, they were asked to consider what level of fetal risk of death or serious disability they would consider acceptable to avoid cesarean and achieve vaginal birth. RESULTS The median level of fetal risk deemed acceptable to achieve a vaginal birth for pregnant women was 10 per 10,000 births (95% confidence interval [CI] 10-13 per 10,000), although the range of responses was wide (1-5,000 per 10,000). Among staff, the median level of acceptable fetal risk was 13 per 10,000 births (95% CI 10-20 per 10,000). Women participating in lower intervention models of care, such as the birth center or team midwifery, were more tolerant of fetal risk (odds ratios [ORs] 2.1, 95% CI 1.6-2.9 and 1.5, 95% CI 1.0-2.3, for accepting a fetal risk of 20 per 10,000 or greater), whereas women with a complicated pregnancy were less tolerant of fetal risk (OR 0.7, 95% CI 0.5-0.9). CONCLUSION Pregnant women and their caregivers have a low tolerance for fetal risk associated with vaginal birth. This study demonstrates the difficulty of minimizing obstetric intervention rates in the face of high expectations for fetal outcome. Obstetric and demographic factors were found to significantly impact the "acceptable fetal risk" threshold, which highlights the importance of individualized counseling regarding mode of birth. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- Susan P Walker
- Department of Obstetrics and Gynaecology, University of Melbourne, Victoria, Australia.
| | | | | | | | | | | |
Collapse
|