Abstract
ObjectivesTo describe the unevenness in daily patient flow (quiet, optimal and busy days) in different sized delivery hospitals. Study designPopulation based register-study of 610 227 hospital deliveries. Data were collected from the Finnish Medical Birth Register from 2006 to 2016. Delivery hospitals (N = 26) were stratified into four categories by annual delivery volume: C1 <1000, C2 1000–1999, C3 2000–2999, C4 ≥3000. Uneven daily patient flow was defined based on the mean of daily delivery volume for each hospital category: quiet day (≤50% of the mean), optimal day (>50% of the mean to <two times the mean) and busy day (≥two times the mean or more). ResultsThe mean of daily delivery volume varied from 2.0 to 12.6 between the smallest and the largest hospital, respectively in hospital categories C1 and C4. The daily delivery volume was optimal in 41.2%, 68.3%, 84.0%, and 91.0% of the days in hospital categories C1, C2, C3, and C4, respectively. In the smallest hospitals (C1) almost half of the days appeared to be quiet (42.9%) whereas in the larger hospitals approximately one in four (25.4%), one in seven (13.6%), and less than one in ten of the days were quiet, in the categories C2, C3, and C4 respectively. Busy days were most common in the smallest hospitals (C1) where one in six of the day (15.9%) had daily delivery volume ≥two times the mean or more. In the other hospital categories busy days were rare, and the lowest in the largest hospitals. ConclusionsUnevenness in daily patient flow was more prominent in the smaller delivery units compared to larger ones. Quiet and busy days both caused challenges to delivery unit organisations. During quiet days, fully over-resourcing of staffing occurred whereas during busy days there was a risk of under-resourcing. It is possible to optimise the size of delivery units to minimise the variation of the daily patient flow to decrease the number of quiet and busy days.
Highlights
A decreasing birth rate in European countries has led to the trend of health care centralisation and to the closure of the small delivery hospitals
Uneven daily patient flow was defined based on the mean of daily delivery volume for each hospital category: quiet day ( 50% of the mean), optimal day (>50% of the mean to
Description of annual and daily delivery volumes as well as distribution of optimal, quiet, and busy days determined based on mean and range of daily delivery volume in each of the four hospital categories are shown in the Table 1
Summary
A decreasing birth rate in European countries has led to the trend of health care centralisation and to the closure of the small delivery hospitals. The delivery hospitals annual delivery volume has been used as an indicator for the quality of perinatal care. The earlier studies of the effect of delivery units annual delivery volume have shown partly contradictory results. While some European studies demonstrate clearly improved outcomes of very preterm infants in tertiary level hospitals [2,3,4], the others indicate that the size of delivery units had no or minor effect on perinatal outcomes [5,6,7]. It is very difficult to compare the results of these studies due to the various endpoints and due to differences in maternity care services, country size and population density.
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