Severe and Fatal Obstetric Injury Claims in Relation to Labor Unit Volume

Abstract

Although obstetric severe adverse outcomes due to medical errors are not common, they can be devastating for families. High-volume labor units might be cost-effective, but smaller labor units may provide more personalized care and be located more closely to individuals in lower-density areas. This study examines obstetric injury claims and assesses any association between the delivery volume in Denmark and the incidences of approved severe and fatal obstetric injury claims. Data were collected from the Danish Patient Compensation Associations and the Danish Medical Birth Register, which includes information on all hospital and home births since 1973 in Denmark. Since 1995, approximately 37 obstetric claims have been approved each year. Even if the practitioner involved in a claim was not held legally responsible, patients may have claims approved and be compensated. Labor units were categorized in 5 groups of annual volume quantity range. Primary outcomes included submitted claims, approved claims, approved severe injury claims, approved fatal injury claims, and approved severe and fatal injury claims combined. Between 1995 and 2012, more than 1 million children were born, and more than 98% were delivered in hospital labor units; 1,151,734 births from 51 labor units were included in the study. During the 18-year study period, the median volume of labor units had an increase of 40 deliveries per year (P < 0.001). A total of 1872 claims, 672 of which were approved, were included in the study. Of the approved claims, 64 patients were severely injured, 4 died of injuries, and 91 died (84 children and 7 mothers). Overall, the incidence rate of approved claims was 5.8 per 10,000 births (95% confidence interval, 5.41–6.29 births). The 3 lowest-volume quintiles (<2802 deliveries per year) had 30% to 40% increased approval incidence rates compared with the fifth quintile (3800–6000 deliveries per year). The incidence rate of approved claims was inversely related to unit volume. These findings show that higher-volume labor units have a lower incidence rate of approved injury claims and lower rate of approved fatal injury claims than higher-volume labor units. Factors that may contribute to this is the smaller number of qualified specialists and lack of accessibility to specialties such as anesthesia or neonatology at smaller units. While these findings support the development of larger labor units from the consolidation of small units, it is also important to create obstetric safety initiatives tailored to unit volume.