Busy day effect on adverse obstetric outcomes using a nationwide ecosystem approach: Cross-sectional register study of 601 247 hospital deliveries

Objective: To study the busy day effect on selected neonatal adverse outcomes in different sized delivery hospitals and in the entire nationwide obstetric ecosystem.Design: A cross-sectional register study.Setting: The lowest and highest 10% of the daily delivery volume distribution were defined as quiet and busy days, respectively. The days between (80%) were defined as optimal delivery volume days. The differences in the incidence of selected adverse neonatal outcome measures were analysed between busy versus optimal days and quiet versus optimal days at the hospital category and for the entire obstetric ecosystem level.Population; A total of 601 247 singleton hospital deliveries between 2006 and 2016, occurred in non-tertiary (C1-C4, stratified by size) and tertiary level (C5) delivery hospitals.Methods: Analyses were performed by the methods of the regression analyses with crude and adjusted odds ratios including 99% CI.Main outcome measuresBirth asphyxia.Results: At the ecosystem level, adjusted odds ratio for birth asphyxia was 0.81 (99% CI 0.76-0.87) on busy versus optimal days. Breakdown to hospital categories show that adjusted odds ratios for asphyxia on busy versus optimal days in non-tertiary hospitals (C3, C4) were 0.25 (99% CI 0.16-0.41) and 0.17 (99% CI 0.13-0.22), respectively, and in tertiary hospitals was 1.20 (99% CI 1.10-1.32).Conclusions: Busy day effect as a stress test caused no extra cases of neonatal adverse outcomes at the ecosystem level. However, in non-tertiary hospitals busy days were associated with a lower and in tertiary hospitals a higher incidence of neonatal adverse outcomes.

Automated summary

The objective of this study is to examine the impact of busy work days on selected neonatal adverse outcomes in different sized delivery hospitals and the entire national obstetric ecosystem. A cross-sectional register study was conducted to analyze the differences in the incidence of adverse outcomes between busy and optimal days at hospital and ecosystem levels. Results show that at the ecosystem level, the adjusted odds ratio for birth asphyxia was 0.81 on busy versus optimal days. Breakdown analysis by hospital categories revealed that in non-tertiary hospitals, the adjusted odds ratios for asphyxia on busy versus optimal days were 0.25 and 0.17, while in tertiary hospitals it was 1.20. Consequently, the busy day effect has varying impacts on neonatal adverse outcomes depending on the type of hospital.