Differences in obstetrical care and outcomes associated with the proportion of the obstetrician’s shift completed

Understanding and improving obstetrical quality and safety is an important goal of professional societies, and many interventions such as checklists, safety bundles, educational interventions, or other culture changes have been implemented to improve the quality of care provided to obstetrical patie...

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Veröffentlicht in:	American journal of obstetrics and gynecology 2021-10, Vol.225 (4), p.430.e1-430.e11
Hauptverfasser:	Yee, Lynn M., McGee, Paula, Bailit, Jennifer L., Wapner, Ronald J., Varner, Michael W., Thorp, John M., Caritis, Steve N., Prasad, Mona, Saade, George R., Sorokin, Yoram, Rouse, Dwight J., Tolosa, Jorge E., Mallett, G., Grobman, W., Stein, L., Campbell, P., Collins, C., Senka, J., Paychek, K., Peaceman, A., Zylfijaj, M., Reid, Z., Leed, R., Forester, S., Davis, S., Falk, M., Perez, C., Sowles, A., Postma, J., Alexander, S., Andersen, G., Scott, V., Morby, V., Jolley, K., Berg, B., Dorman, K., Mitchell, J., Spicer, K., Timlin, S., Wilson, K., Price, J., Kingsbery, J., Benezue, R., Bickus, M., Fischer, D., DeAngelis, D., Mercer, B., McDonald, P., Latimer, C., Guzzo, L., Gerwig, L., Loux, D., Frantz, S., Cline, D., Wylie, S., Iams, J., Wallace, M., Northen, A., Grant, J., Colquitt, C., Rouse, D., Andrews, W., Moss, J., Salazar, A., Acosta, A., Hauff, N., Palmer, L., Lockhart, P., Driscoll, D., Sudz, C., Dengate, D., Smith, F., Allard, D., Hunt, J., Tillinghast, J., Corcoran, N., Ortiz, F., Rech, B., Moran, C., Hutchinson, M., Spears, Z., Heaps, B., Zamora, G., Seguin, J., Rincon, M., Snyder, J., Farrar, C., Lairson, E., Bonino, C., Beach, K., Van Dyke, S., Thom, E., Rice, M., Zhao, Y., Momirova, V., Palugod, R., Reamer, B., Larsen, M., Tolivaisa, S., VanDorsten, J.P.
Format:	Artikel
Sprache:	eng
Schlagworte:	Adult adverse perinatal outcomes Apgar Score Cesarean Section - statistics & numerical data Episiotomy - statistics & numerical data Female Humans Intensive Care Units, Neonatal - statistics & numerical data Lacerations - epidemiology Logistic Models Obstetric Labor Complications - epidemiology obstetrical interventions Obstetrics Perineum - injuries Personnel Staffing and Scheduling - statistics & numerical data Physicians Pregnancy provider fatigue quality improvement quality of care Quality of Health Care shift change Young Adult
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container_title	American journal of obstetrics and gynecology
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creator	Yee, Lynn M. McGee, Paula Bailit, Jennifer L. Wapner, Ronald J. Varner, Michael W. Thorp, John M. Caritis, Steve N. Prasad, Mona Saade, George R. Sorokin, Yoram Rouse, Dwight J. Tolosa, Jorge E. Mallett, G. Grobman, W. Stein, L. Campbell, P. Collins, C. Senka, J. Paychek, K. Peaceman, A. Zylfijaj, M. Reid, Z. Leed, R. Forester, S. Davis, S. Falk, M. Perez, C. Sowles, A. Postma, J. Alexander, S. Andersen, G. Scott, V. Morby, V. Jolley, K. Berg, B. Dorman, K. Mitchell, J. Spicer, K. Timlin, S. Wilson, K. Price, J. Kingsbery, J. Benezue, R. Bickus, M. Fischer, D. DeAngelis, D. Mercer, B. McDonald, P. Latimer, C. Guzzo, L. Gerwig, L. Loux, D. Frantz, S. Cline, D. Wylie, S. Iams, J. Wallace, M. Northen, A. Grant, J. Colquitt, C. Rouse, D. Andrews, W. Moss, J. Salazar, A. Acosta, A. Hauff, N. Palmer, L. Lockhart, P. Driscoll, D. Sudz, C. Dengate, D. Smith, F. Allard, D. Hunt, J. Tillinghast, J. Corcoran, N. Ortiz, F. Rech, B. Moran, C. Hutchinson, M. Spears, Z. Heaps, B. Zamora, G. Seguin, J. Rincon, M. Snyder, J. Farrar, C. Lairson, E. Bonino, C. Beach, K. Van Dyke, S. Thom, E. Rice, M. Zhao, Y. Momirova, V. Palugod, R. Reamer, B. Larsen, M. Tolivaisa, S. VanDorsten, J.P.
description	Understanding and improving obstetrical quality and safety is an important goal of professional societies, and many interventions such as checklists, safety bundles, educational interventions, or other culture changes have been implemented to improve the quality of care provided to obstetrical patients. Although many factors contribute to delivery decisions, a reduced workload has addressed how provider issues such as fatigue or behaviors surrounding impending shift changes may influence the delivery mode and outcomes. The objective was to assess whether intrapartum obstetrical interventions and adverse outcomes differ based on the temporal proximity of the delivery to the attending’s shift change. This was a secondary analysis from a multicenter obstetrical cohort in which all patients with cephalic, singleton gestations who attempted vaginal birth were eligible for inclusion. The primary exposure used to quantify the relationship between the proximity of the provider to their shift change and a delivery intervention was the ratio of time from the most recent attending shift change to vaginal delivery or decision for cesarean delivery to the total length of the shift. Ratios were used to represent the proportion of time completed in the shift by normalizing for varying shift lengths. A sensitivity analysis restricted to patients who were delivered by physicians working 12-hour shifts was performed. Outcomes chosen included cesarean delivery, episiotomy, third- or fourth-degree perineal laceration, 5-minute Apgar score of
doi_str_mv	10.1016/j.ajog.2021.03.033
format	Article
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Although many factors contribute to delivery decisions, a reduced workload has addressed how provider issues such as fatigue or behaviors surrounding impending shift changes may influence the delivery mode and outcomes. The objective was to assess whether intrapartum obstetrical interventions and adverse outcomes differ based on the temporal proximity of the delivery to the attending’s shift change. This was a secondary analysis from a multicenter obstetrical cohort in which all patients with cephalic, singleton gestations who attempted vaginal birth were eligible for inclusion. The primary exposure used to quantify the relationship between the proximity of the provider to their shift change and a delivery intervention was the ratio of time from the most recent attending shift change to vaginal delivery or decision for cesarean delivery to the total length of the shift. Ratios were used to represent the proportion of time completed in the shift by normalizing for varying shift lengths. A sensitivity analysis restricted to patients who were delivered by physicians working 12-hour shifts was performed. Outcomes chosen included cesarean delivery, episiotomy, third- or fourth-degree perineal laceration, 5-minute Apgar score of <4, and neonatal intensive care unit admission. Chi-squared tests were used to evaluate outcomes based on the proportion of the attending’s shift completed. Adjusted and unadjusted logistic models fitting a cubic spline (when indicated) were used to determine whether the frequency of outcomes throughout the shift occurred in a statistically significant, nonlinear pattern Of the 82,851 patients eligible for inclusion, 47,262 (57%) had ratio data available and constituted the analyzable sample. Deliveries were evenly distributed throughout shifts, with 50.6% taking place in the first half of shifts. There were no statistically significant differences in the frequency of cesarean delivery, episiotomy, third- or fourth-degree perineal lacerations, or 5-minute Apgar scores of <4 based on the proportion of the shift completed. The findings were unchanged when evaluated with a cubic spline in unadjusted and adjusted logistic models. Sensitivity analyses performed on the 22.2% of patients who were delivered by a physician completing a 12-hour shift showed similar findings. There was a small increase in the frequency of neonatal intensive care unit admissions with a greater proportion of the shift completed (adjusted P=.009), but the findings did not persist in the sensitivity analysis. Clinically significant differences in obstetrical interventions and outcomes do not seem to exist based on the temporal proximity to the attending physician’s shift change. Future work should attempt to directly study unit culture and provider fatigue to further investigate opportunities to improve obstetrical quality of care, and additional studies are needed to corroborate these findings in community settings.</description><identifier>ISSN: 0002-9378</identifier><identifier>EISSN: 1097-6868</identifier><identifier>DOI: 10.1016/j.ajog.2021.03.033</identifier><identifier>PMID: 33812810</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adult ; adverse perinatal outcomes ; Apgar Score ; Cesarean Section - statistics & numerical data ; Episiotomy - statistics & numerical data ; Female ; Humans ; Intensive Care Units, Neonatal - statistics & numerical data ; Lacerations - epidemiology ; Logistic Models ; Obstetric Labor Complications - epidemiology ; obstetrical interventions ; Obstetrics ; Perineum - injuries ; Personnel Staffing and Scheduling - statistics & numerical data ; Physicians ; Pregnancy ; provider fatigue ; quality improvement ; quality of care ; Quality of Health Care ; shift change ; Young Adult</subject><ispartof>American journal of obstetrics and gynecology, 2021-10, Vol.225 (4), p.430.e1-430.e11</ispartof><rights>2021 Elsevier Inc.</rights><rights>Copyright © 2021 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c351t-32ab67c0a5c2da135dcb8677a12d8aa4f84038022da4b0d42cacb8a87fad1c933</cites><orcidid>0000-0002-6274-0544</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0002937821002131$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33812810$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Yee, Lynn M.</creatorcontrib><creatorcontrib>McGee, Paula</creatorcontrib><creatorcontrib>Bailit, Jennifer L.</creatorcontrib><creatorcontrib>Wapner, Ronald J.</creatorcontrib><creatorcontrib>Varner, Michael W.</creatorcontrib><creatorcontrib>Thorp, John M.</creatorcontrib><creatorcontrib>Caritis, Steve N.</creatorcontrib><creatorcontrib>Prasad, Mona</creatorcontrib><creatorcontrib>Saade, George R.</creatorcontrib><creatorcontrib>Sorokin, Yoram</creatorcontrib><creatorcontrib>Rouse, Dwight J.</creatorcontrib><creatorcontrib>Tolosa, Jorge E.</creatorcontrib><creatorcontrib>Mallett, G.</creatorcontrib><creatorcontrib>Grobman, W.</creatorcontrib><creatorcontrib>Stein, L.</creatorcontrib><creatorcontrib>Campbell, P.</creatorcontrib><creatorcontrib>Collins, C.</creatorcontrib><creatorcontrib>Senka, J.</creatorcontrib><creatorcontrib>Paychek, K.</creatorcontrib><creatorcontrib>Peaceman, A.</creatorcontrib><creatorcontrib>Zylfijaj, M.</creatorcontrib><creatorcontrib>Reid, Z.</creatorcontrib><creatorcontrib>Leed, R.</creatorcontrib><creatorcontrib>Forester, S.</creatorcontrib><creatorcontrib>Davis, S.</creatorcontrib><creatorcontrib>Falk, M.</creatorcontrib><creatorcontrib>Perez, C.</creatorcontrib><creatorcontrib>Sowles, A.</creatorcontrib><creatorcontrib>Postma, J.</creatorcontrib><creatorcontrib>Alexander, S.</creatorcontrib><creatorcontrib>Andersen, G.</creatorcontrib><creatorcontrib>Scott, V.</creatorcontrib><creatorcontrib>Morby, V.</creatorcontrib><creatorcontrib>Jolley, K.</creatorcontrib><creatorcontrib>Berg, B.</creatorcontrib><creatorcontrib>Dorman, K.</creatorcontrib><creatorcontrib>Mitchell, J.</creatorcontrib><creatorcontrib>Spicer, K.</creatorcontrib><creatorcontrib>Timlin, S.</creatorcontrib><creatorcontrib>Wilson, K.</creatorcontrib><creatorcontrib>Price, J.</creatorcontrib><creatorcontrib>Kingsbery, J.</creatorcontrib><creatorcontrib>Benezue, R.</creatorcontrib><creatorcontrib>Bickus, M.</creatorcontrib><creatorcontrib>Fischer, D.</creatorcontrib><creatorcontrib>DeAngelis, D.</creatorcontrib><creatorcontrib>Mercer, B.</creatorcontrib><creatorcontrib>McDonald, P.</creatorcontrib><creatorcontrib>Latimer, C.</creatorcontrib><creatorcontrib>Guzzo, L.</creatorcontrib><creatorcontrib>Gerwig, L.</creatorcontrib><creatorcontrib>Loux, D.</creatorcontrib><creatorcontrib>Frantz, S.</creatorcontrib><creatorcontrib>Cline, D.</creatorcontrib><creatorcontrib>Wylie, S.</creatorcontrib><creatorcontrib>Iams, J.</creatorcontrib><creatorcontrib>Wallace, M.</creatorcontrib><creatorcontrib>Northen, A.</creatorcontrib><creatorcontrib>Grant, J.</creatorcontrib><creatorcontrib>Colquitt, C.</creatorcontrib><creatorcontrib>Rouse, D.</creatorcontrib><creatorcontrib>Andrews, W.</creatorcontrib><creatorcontrib>Moss, J.</creatorcontrib><creatorcontrib>Salazar, A.</creatorcontrib><creatorcontrib>Acosta, A.</creatorcontrib><creatorcontrib>Hauff, N.</creatorcontrib><creatorcontrib>Palmer, L.</creatorcontrib><creatorcontrib>Lockhart, P.</creatorcontrib><creatorcontrib>Driscoll, D.</creatorcontrib><creatorcontrib>Sudz, C.</creatorcontrib><creatorcontrib>Dengate, D.</creatorcontrib><creatorcontrib>Smith, F.</creatorcontrib><creatorcontrib>Allard, D.</creatorcontrib><creatorcontrib>Hunt, J.</creatorcontrib><creatorcontrib>Tillinghast, J.</creatorcontrib><creatorcontrib>Corcoran, N.</creatorcontrib><creatorcontrib>Ortiz, F.</creatorcontrib><creatorcontrib>Rech, B.</creatorcontrib><creatorcontrib>Moran, C.</creatorcontrib><creatorcontrib>Hutchinson, M.</creatorcontrib><creatorcontrib>Spears, Z.</creatorcontrib><creatorcontrib>Heaps, B.</creatorcontrib><creatorcontrib>Zamora, G.</creatorcontrib><creatorcontrib>Seguin, J.</creatorcontrib><creatorcontrib>Rincon, M.</creatorcontrib><creatorcontrib>Snyder, J.</creatorcontrib><creatorcontrib>Farrar, C.</creatorcontrib><creatorcontrib>Lairson, E.</creatorcontrib><creatorcontrib>Bonino, C.</creatorcontrib><creatorcontrib>Beach, K.</creatorcontrib><creatorcontrib>Van Dyke, S.</creatorcontrib><creatorcontrib>Thom, E.</creatorcontrib><creatorcontrib>Rice, M.</creatorcontrib><creatorcontrib>Zhao, Y.</creatorcontrib><creatorcontrib>Momirova, V.</creatorcontrib><creatorcontrib>Palugod, R.</creatorcontrib><creatorcontrib>Reamer, B.</creatorcontrib><creatorcontrib>Larsen, M.</creatorcontrib><creatorcontrib>Tolivaisa, S.</creatorcontrib><creatorcontrib>VanDorsten, J.P.</creatorcontrib><creatorcontrib>National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network</creatorcontrib><creatorcontrib>Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network</creatorcontrib><title>Differences in obstetrical care and outcomes associated with the proportion of the obstetrician’s shift completed</title><title>American journal of obstetrics and gynecology</title><addtitle>Am J Obstet Gynecol</addtitle><description>Understanding and improving obstetrical quality and safety is an important goal of professional societies, and many interventions such as checklists, safety bundles, educational interventions, or other culture changes have been implemented to improve the quality of care provided to obstetrical patients. Although many factors contribute to delivery decisions, a reduced workload has addressed how provider issues such as fatigue or behaviors surrounding impending shift changes may influence the delivery mode and outcomes. The objective was to assess whether intrapartum obstetrical interventions and adverse outcomes differ based on the temporal proximity of the delivery to the attending’s shift change. This was a secondary analysis from a multicenter obstetrical cohort in which all patients with cephalic, singleton gestations who attempted vaginal birth were eligible for inclusion. The primary exposure used to quantify the relationship between the proximity of the provider to their shift change and a delivery intervention was the ratio of time from the most recent attending shift change to vaginal delivery or decision for cesarean delivery to the total length of the shift. Ratios were used to represent the proportion of time completed in the shift by normalizing for varying shift lengths. A sensitivity analysis restricted to patients who were delivered by physicians working 12-hour shifts was performed. Outcomes chosen included cesarean delivery, episiotomy, third- or fourth-degree perineal laceration, 5-minute Apgar score of <4, and neonatal intensive care unit admission. Chi-squared tests were used to evaluate outcomes based on the proportion of the attending’s shift completed. Adjusted and unadjusted logistic models fitting a cubic spline (when indicated) were used to determine whether the frequency of outcomes throughout the shift occurred in a statistically significant, nonlinear pattern Of the 82,851 patients eligible for inclusion, 47,262 (57%) had ratio data available and constituted the analyzable sample. Deliveries were evenly distributed throughout shifts, with 50.6% taking place in the first half of shifts. There were no statistically significant differences in the frequency of cesarean delivery, episiotomy, third- or fourth-degree perineal lacerations, or 5-minute Apgar scores of <4 based on the proportion of the shift completed. The findings were unchanged when evaluated with a cubic spline in unadjusted and adjusted logistic models. Sensitivity analyses performed on the 22.2% of patients who were delivered by a physician completing a 12-hour shift showed similar findings. There was a small increase in the frequency of neonatal intensive care unit admissions with a greater proportion of the shift completed (adjusted P=.009), but the findings did not persist in the sensitivity analysis. Clinically significant differences in obstetrical interventions and outcomes do not seem to exist based on the temporal proximity to the attending physician’s shift change. Future work should attempt to directly study unit culture and provider fatigue to further investigate opportunities to improve obstetrical quality of care, and additional studies are needed to corroborate these findings in community settings.</description><subject>Adult</subject><subject>adverse perinatal outcomes</subject><subject>Apgar Score</subject><subject>Cesarean Section - statistics & numerical data</subject><subject>Episiotomy - statistics & numerical data</subject><subject>Female</subject><subject>Humans</subject><subject>Intensive Care Units, Neonatal - statistics & numerical data</subject><subject>Lacerations - epidemiology</subject><subject>Logistic Models</subject><subject>Obstetric Labor Complications - epidemiology</subject><subject>obstetrical interventions</subject><subject>Obstetrics</subject><subject>Perineum - injuries</subject><subject>Personnel Staffing and Scheduling - statistics & numerical data</subject><subject>Physicians</subject><subject>Pregnancy</subject><subject>provider fatigue</subject><subject>quality improvement</subject><subject>quality of care</subject><subject>Quality of Health Care</subject><subject>shift change</subject><subject>Young 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Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-6274-0544</orcidid></search><sort><creationdate>202110</creationdate><title>Differences in obstetrical care and outcomes associated with the proportion of the obstetrician’s shift completed</title><author>Yee, Lynn M. ; McGee, Paula ; Bailit, Jennifer L. ; Wapner, Ronald J. ; Varner, Michael W. ; Thorp, John M. ; Caritis, Steve N. ; Prasad, Mona ; Saade, George R. ; Sorokin, Yoram ; Rouse, Dwight J. ; Tolosa, Jorge E. ; Mallett, G. ; Grobman, W. ; Stein, L. ; Campbell, P. ; Collins, C. ; Senka, J. ; Paychek, K. ; Peaceman, A. ; Zylfijaj, M. ; Reid, Z. ; Leed, R. ; Forester, S. ; Davis, S. ; Falk, M. ; Perez, C. ; Sowles, A. ; Postma, J. ; Alexander, S. ; Andersen, G. ; Scott, V. ; Morby, V. ; Jolley, K. ; Berg, B. ; Dorman, K. ; Mitchell, J. ; Spicer, K. ; Timlin, S. ; Wilson, K. ; Price, J. ; Kingsbery, J. ; Benezue, R. ; Bickus, M. ; Fischer, D. ; DeAngelis, D. ; Mercer, B. ; McDonald, P. ; Latimer, C. ; Guzzo, L. ; Gerwig, L. ; Loux, D. ; Frantz, S. ; Cline, D. ; Wylie, S. ; Iams, J. ; Wallace, M. ; Northen, A. ; Grant, J. ; Colquitt, C. ; Rouse, D. ; Andrews, W. ; Moss, J. ; Salazar, A. ; Acosta, A. ; Hauff, N. ; Palmer, L. ; Lockhart, P. ; Driscoll, D. ; Sudz, C. ; Dengate, D. ; Smith, F. ; Allard, D. ; Hunt, J. ; Tillinghast, J. ; Corcoran, N. ; Ortiz, F. ; Rech, B. ; Moran, C. ; Hutchinson, M. ; Spears, Z. ; Heaps, B. ; Zamora, G. ; Seguin, J. ; Rincon, M. ; Snyder, J. ; Farrar, C. ; Lairson, E. ; Bonino, C. ; Beach, K. ; Van Dyke, S. ; Thom, E. ; Rice, M. ; Zhao, Y. ; Momirova, V. ; Palugod, R. ; Reamer, B. ; Larsen, M. ; Tolivaisa, S. ; VanDorsten, J.P.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c351t-32ab67c0a5c2da135dcb8677a12d8aa4f84038022da4b0d42cacb8a87fad1c933</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Adult</topic><topic>adverse perinatal outcomes</topic><topic>Apgar Score</topic><topic>Cesarean Section - statistics & numerical data</topic><topic>Episiotomy - statistics & numerical data</topic><topic>Female</topic><topic>Humans</topic><topic>Intensive Care Units, Neonatal - statistics & numerical data</topic><topic>Lacerations - epidemiology</topic><topic>Logistic Models</topic><topic>Obstetric Labor Complications - epidemiology</topic><topic>obstetrical interventions</topic><topic>Obstetrics</topic><topic>Perineum - injuries</topic><topic>Personnel Staffing and Scheduling - statistics & numerical data</topic><topic>Physicians</topic><topic>Pregnancy</topic><topic>provider fatigue</topic><topic>quality improvement</topic><topic>quality of care</topic><topic>Quality of Health Care</topic><topic>shift change</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Yee, Lynn M.</creatorcontrib><creatorcontrib>McGee, Paula</creatorcontrib><creatorcontrib>Bailit, Jennifer L.</creatorcontrib><creatorcontrib>Wapner, Ronald J.</creatorcontrib><creatorcontrib>Varner, Michael W.</creatorcontrib><creatorcontrib>Thorp, John M.</creatorcontrib><creatorcontrib>Caritis, Steve N.</creatorcontrib><creatorcontrib>Prasad, Mona</creatorcontrib><creatorcontrib>Saade, George R.</creatorcontrib><creatorcontrib>Sorokin, Yoram</creatorcontrib><creatorcontrib>Rouse, Dwight J.</creatorcontrib><creatorcontrib>Tolosa, Jorge E.</creatorcontrib><creatorcontrib>Mallett, G.</creatorcontrib><creatorcontrib>Grobman, W.</creatorcontrib><creatorcontrib>Stein, L.</creatorcontrib><creatorcontrib>Campbell, 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M.</creatorcontrib><creatorcontrib>Snyder, J.</creatorcontrib><creatorcontrib>Farrar, C.</creatorcontrib><creatorcontrib>Lairson, E.</creatorcontrib><creatorcontrib>Bonino, C.</creatorcontrib><creatorcontrib>Beach, K.</creatorcontrib><creatorcontrib>Van Dyke, S.</creatorcontrib><creatorcontrib>Thom, E.</creatorcontrib><creatorcontrib>Rice, M.</creatorcontrib><creatorcontrib>Zhao, Y.</creatorcontrib><creatorcontrib>Momirova, V.</creatorcontrib><creatorcontrib>Palugod, R.</creatorcontrib><creatorcontrib>Reamer, B.</creatorcontrib><creatorcontrib>Larsen, M.</creatorcontrib><creatorcontrib>Tolivaisa, S.</creatorcontrib><creatorcontrib>VanDorsten, J.P.</creatorcontrib><creatorcontrib>National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network</creatorcontrib><creatorcontrib>Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>American journal of obstetrics and gynecology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Yee, Lynn M.</au><au>McGee, Paula</au><au>Bailit, Jennifer L.</au><au>Wapner, Ronald J.</au><au>Varner, Michael W.</au><au>Thorp, John M.</au><au>Caritis, Steve N.</au><au>Prasad, Mona</au><au>Saade, George R.</au><au>Sorokin, Yoram</au><au>Rouse, Dwight J.</au><au>Tolosa, Jorge E.</au><au>Mallett, G.</au><au>Grobman, W.</au><au>Stein, L.</au><au>Campbell, P.</au><au>Collins, C.</au><au>Senka, J.</au><au>Paychek, K.</au><au>Peaceman, A.</au><au>Zylfijaj, M.</au><au>Reid, Z.</au><au>Leed, R.</au><au>Forester, S.</au><au>Davis, S.</au><au>Falk, M.</au><au>Perez, C.</au><au>Sowles, A.</au><au>Postma, J.</au><au>Alexander, S.</au><au>Andersen, G.</au><au>Scott, V.</au><au>Morby, V.</au><au>Jolley, K.</au><au>Berg, B.</au><au>Dorman, K.</au><au>Mitchell, J.</au><au>Spicer, K.</au><au>Timlin, S.</au><au>Wilson, K.</au><au>Price, J.</au><au>Kingsbery, J.</au><au>Benezue, R.</au><au>Bickus, M.</au><au>Fischer, D.</au><au>DeAngelis, D.</au><au>Mercer, B.</au><au>McDonald, P.</au><au>Latimer, C.</au><au>Guzzo, L.</au><au>Gerwig, L.</au><au>Loux, D.</au><au>Frantz, S.</au><au>Cline, D.</au><au>Wylie, S.</au><au>Iams, J.</au><au>Wallace, M.</au><au>Northen, A.</au><au>Grant, J.</au><au>Colquitt, C.</au><au>Rouse, D.</au><au>Andrews, W.</au><au>Moss, J.</au><au>Salazar, A.</au><au>Acosta, A.</au><au>Hauff, N.</au><au>Palmer, L.</au><au>Lockhart, P.</au><au>Driscoll, D.</au><au>Sudz, C.</au><au>Dengate, D.</au><au>Smith, F.</au><au>Allard, D.</au><au>Hunt, J.</au><au>Tillinghast, J.</au><au>Corcoran, N.</au><au>Ortiz, F.</au><au>Rech, B.</au><au>Moran, C.</au><au>Hutchinson, M.</au><au>Spears, Z.</au><au>Heaps, B.</au><au>Zamora, G.</au><au>Seguin, J.</au><au>Rincon, M.</au><au>Snyder, J.</au><au>Farrar, C.</au><au>Lairson, E.</au><au>Bonino, C.</au><au>Beach, K.</au><au>Van Dyke, S.</au><au>Thom, E.</au><au>Rice, M.</au><au>Zhao, Y.</au><au>Momirova, V.</au><au>Palugod, R.</au><au>Reamer, B.</au><au>Larsen, M.</au><au>Tolivaisa, S.</au><au>VanDorsten, J.P.</au><aucorp>National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network</aucorp><aucorp>Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Differences in obstetrical care and outcomes associated with the proportion of the obstetrician’s shift completed</atitle><jtitle>American journal of obstetrics and gynecology</jtitle><addtitle>Am J Obstet Gynecol</addtitle><date>2021-10</date><risdate>2021</risdate><volume>225</volume><issue>4</issue><spage>430.e1</spage><epage>430.e11</epage><pages>430.e1-430.e11</pages><issn>0002-9378</issn><eissn>1097-6868</eissn><abstract>Understanding and improving obstetrical quality and safety is an important goal of professional societies, and many interventions such as checklists, safety bundles, educational interventions, or other culture changes have been implemented to improve the quality of care provided to obstetrical patients. Although many factors contribute to delivery decisions, a reduced workload has addressed how provider issues such as fatigue or behaviors surrounding impending shift changes may influence the delivery mode and outcomes. The objective was to assess whether intrapartum obstetrical interventions and adverse outcomes differ based on the temporal proximity of the delivery to the attending’s shift change. This was a secondary analysis from a multicenter obstetrical cohort in which all patients with cephalic, singleton gestations who attempted vaginal birth were eligible for inclusion. The primary exposure used to quantify the relationship between the proximity of the provider to their shift change and a delivery intervention was the ratio of time from the most recent attending shift change to vaginal delivery or decision for cesarean delivery to the total length of the shift. Ratios were used to represent the proportion of time completed in the shift by normalizing for varying shift lengths. A sensitivity analysis restricted to patients who were delivered by physicians working 12-hour shifts was performed. Outcomes chosen included cesarean delivery, episiotomy, third- or fourth-degree perineal laceration, 5-minute Apgar score of <4, and neonatal intensive care unit admission. Chi-squared tests were used to evaluate outcomes based on the proportion of the attending’s shift completed. Adjusted and unadjusted logistic models fitting a cubic spline (when indicated) were used to determine whether the frequency of outcomes throughout the shift occurred in a statistically significant, nonlinear pattern Of the 82,851 patients eligible for inclusion, 47,262 (57%) had ratio data available and constituted the analyzable sample. Deliveries were evenly distributed throughout shifts, with 50.6% taking place in the first half of shifts. There were no statistically significant differences in the frequency of cesarean delivery, episiotomy, third- or fourth-degree perineal lacerations, or 5-minute Apgar scores of <4 based on the proportion of the shift completed. The findings were unchanged when evaluated with a cubic spline in unadjusted and adjusted logistic models. Sensitivity analyses performed on the 22.2% of patients who were delivered by a physician completing a 12-hour shift showed similar findings. There was a small increase in the frequency of neonatal intensive care unit admissions with a greater proportion of the shift completed (adjusted P=.009), but the findings did not persist in the sensitivity analysis. Clinically significant differences in obstetrical interventions and outcomes do not seem to exist based on the temporal proximity to the attending physician’s shift change. Future work should attempt to directly study unit culture and provider fatigue to further investigate opportunities to improve obstetrical quality of care, and additional studies are needed to corroborate these findings in community settings.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>33812810</pmid><doi>10.1016/j.ajog.2021.03.033</doi><orcidid>https://orcid.org/0000-0002-6274-0544</orcidid><oa>free_for_read</oa></addata></record>
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source	MEDLINE; Elsevier ScienceDirect Journals
subjects	Adult adverse perinatal outcomes Apgar Score Cesarean Section - statistics & numerical data Episiotomy - statistics & numerical data Female Humans Intensive Care Units, Neonatal - statistics & numerical data Lacerations - epidemiology Logistic Models Obstetric Labor Complications - epidemiology obstetrical interventions Obstetrics Perineum - injuries Personnel Staffing and Scheduling - statistics & numerical data Physicians Pregnancy provider fatigue quality improvement quality of care Quality of Health Care shift change Young Adult
title	Differences in obstetrical care and outcomes associated with the proportion of the obstetrician’s shift completed
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