Relationships among Neonatal Mortality, Hospital Volume, Weekday Demand, and Weekend Birth [22R

Abstract

INTRODUCTION: Previous research indicated weekend birth and mid-range hospital volume are associated with increased risk of neonatal mortality. This study investigated how the proportion of births occurring Monday through Friday affects risk for neonatal mortality from low birth volume and weekend birth. METHODS: For this retrospective, population-based, cohort-study design, data were obtained from 32,140 electronic birth certificate records matched with 92 death certificate records from the Texas Department of State Health Statistics. The data represented all births and neonatal deaths in one metropolitan county in Texas for the year 2012. Statistical analyses included descriptive procedures, ANOVA, t-test, logistic regression, and chi square tests of association. RESULTS: After adjusting for birth weight and maternal ethnicity, we found the proportion of births occurring Monday through Friday, in hospitals, remained a significant factor affecting odds of neonatal mortality, whereas hospital birth volume and weekend birth did not remain significant predictors. CONCLUSION: The way in which hospitals respond to demand (e.g., allocating staff and other resources) across the week plays an important role in determining neonatal mortality risk, regardless of infants’ birth weight or maternal ethnicity. The study findings could raise awareness of system-level factors and stimulate more thorough, careful assessment and planning by hospital administrators and care providers. More research is needed to determine exactly how acuity and quality interact to increase weekend risk.