Busy days at the delivery hospital may affect care – Quality of obstetric care in Finland remains high

A new study investigated the impact of busy days on the care provided by delivery hospitals. Finnish delivery hospitals offer high-quality care even on the busiest days, unit-specific differences may occur.

The daily number of patients in delivery hospitals typically varies, occasionally resulting in busy days. However, the impact of such busy periods on the quality of obstetric care has not been studied. As the total number of deliveries has decreased in Finland, small delivery hospitals have been closed and services have been centralised in larger units. The staff size of maternity hospitals is determined by the number of deliveries per day on average.

In her doctoral thesis, Riitta Vilkko, MHSc, investigated how quiet and busy days at delivery hospitals associate with the quality of care for mothers and newborns. According to the study, Finnish maternity hospitals offer high-quality care, including on the busiest days, but the quality of care may vary between individual delivery units.

Using quality indicators common in the field, the quality of care was measured based on the number of procedures carried out during labour and diagnosis codes, which describe the outcome of care. Optimal days, during which units function with their optimal capacity, were used as reference category.

Vilkko examined deliveries both on the level of the entire obstetric ecosystem and in separate maternity hospitals categorized by size. The dataset, covering the period 2006–2016, was compiled from the Finnish Medical Birth Register maintained by the Finnish Institute for Health and Welfare. The dataset included information on 634,810 deliveries. The number of busy days varied between delivery units. In large units, operations ran smoother, while in smaller units even minor fluctuation in the patient flow generated a sense of high workload.

Differences in the number of procedures 

Busy days had a varying impact on the number of services provided in individual delivery hospitals. On busy days, larger units were able to carry out procedures related to delivery and provide pain relief in the same way as on other days, if not even more effectively. In smaller units, busy periods partially reduced the number of procedures. For example, the number of caesarean sections in small units decreased during busy days by 18% and on quiet days increased by 15%.

“The differences likely indicate that large hospitals have better capability to conduct interventions during labour, when necessary, compared to smaller units. When busyness is recognised in smaller sized delivery hospital, patients may be referred to larger sized hospitals. On quiet days, smaller units can possibly observe the situation longer before taking such action,” Vilkko estimates.

A similar phenomenon was also seen in the health of newborns. During busy days, the number of intrapartum foetal asphyxia cases, decreased in central hospitals, but increased in university hospitals. According to Vilkko, these cases were most likely referred to larger units from smaller ones.

These cases are likely related to referral practices, since the effects of busy periods were not observed at entire obstetric ecosystem level,” Vilkko says.

According to Vilkko, further research is needed particularly on the circumstances in which delivery hospitals refer women giving birth to other units on busy days, as well as on the grounds for these decisions. Vilkko also posits that busy periods typical of each individual delivery unit should be determined. 

“That would make it possible to further investigate the connection between busyness and the quality of care,” Vilkko says. 

Riitta Vilkko, MHSc, defended her doctoral thesis entitled “Busy day effect on the Finnish obstetric ecosystem” on 10 March 2023 at 12.15 at the Faculty of Medicine, University of Helsinki. Docent Pekka Taipale from the University of Helsinki served as the opponent and Seppo Heinonen as the custos. The doctoral thesis is also available in electronic form through the Helda repository.