Determining obstetric patient safety indicators: the differences in neonatal outcome measures between different-sized delivery units.

Objective: To study the differences in neonatal outcome and treatment measures in Finnish obstetric units.
Design: A registry study with Medical Birth Register data.
Setting and Population: All births (n = 2 94 726) in Finland from 2006 to 2010 with a focus on term, singleton non-university deliveries.
Methods: All 34 delivery units were grouped into small (below 1000), mid-sized (1000-2999) and large (3000 or more) units, and the adverse outcome rates in neonates were compared using logistic regression.
Main Outcome Measures: Early neonatal deaths, stillbirths, Apgar scores, arterial cord pH, Erb's paralysis, respirator treatment, the proportion of post-term deliveries (gestational age beyond 42 weeks) and the proportion of newborns still hospitalised 7 days after delivery.
Results: From an analysis of term, singleton non-university deliveries, the early neonatal mortality was significantly higher in the small relative to the mid-sized delivery units [odds ratio (OR), 2.07; 95% confidence interval (CI), 1.19-3.60]. The rate of Erb's paralysis was lowest in the large units (OR, 0.65; 95% CI, 0.50-0.84). The use of a respirator was more than two-fold more common in large relative to mid-sized units (OR, 2.38; 95% CI, 2.00-2.83). The proportion of post-term deliveries was highest in the large units (OR, 1.36; 95% CI, 1.31-1.42), where a significantly higher percentage of post-term newborns were still hospitalised after 7 days (OR, 1.50; 95% CI, 1.19-1.89).
Conclusions: There are significant differences in several neonatal indicators dependent on the hospital size. An international consensus is needed on which indicators should be used.
(© 2013 Royal College of Obstetricians and Gynaecologists.)