School of Health Sciences, University of Southampton, Southampton, UK
School of Health Sciences, University of Southampton, Southampton, UK.
BMJ Open. 2024 Apr 3;14(4):e077710. doi: 10.1136/bmjopen-2023-077710.
Preventing readmission to hospital after giving birth is a key priority, as rates have been rising along with associated costs. There are many contributing factors to readmission, and some are thought to be preventable. Nurse and midwife understaffing has been linked to deficits in care quality. This study explores the relationship between staffing levels and readmission rates in maternity settings.
We conducted a retrospective longitudinal study using routinely collected individual patient data in three maternity services in England from 2015 to 2020. Data on admissions, discharges and case-mix were extracted from hospital administration systems. Staffing and workload were calculated in Hours Per Patient day per shift in the first two 12-hour shifts of the index (birth) admission. Postpartum readmissions and staffing exposures for all birthing admissions were entered into a hierarchical multivariable logistic regression model to estimate the odds of readmission when staffing was below the mean level for the maternity service.
64 250 maternal admissions resulted in birth and 2903 mothers were readmitted within 30 days of discharge (4.5%). Absolute levels of staffing ranged between 2.3 and 4.1 individuals per midwife in the three services. Below average midwifery staffing was associated with higher rates of postpartum readmissions within 7 days of discharge (adjusted OR (aOR) 1.108, 95% CI 1.003 to 1.223). The effect was smaller and not statistically significant for readmissions within 30 days of discharge (aOR 1.080, 95% CI 0.994 to 1.174). Below average maternity assistant staffing was associated with lower rates of postpartum readmissions (7 days, aOR 0.957, 95% CI 0.867 to 1.057; 30 days aOR 0.965, 95% CI 0.887 to 1.049, both not statistically significant).
We found evidence that lower than expected midwifery staffing levels is associated with more postpartum readmissions. The nature of the relationship requires further investigation including examining potential mediating factors and reasons for readmission in maternity populations.
产后住院再入院率不断上升，导致相关成本增加，因此预防产后住院再入院是一个关键优先事项。导致再入院的因素有很多，有些因素被认为是可以预防的。护士和助产士人手不足与护理质量缺陷有关。本研究探讨了产妇环境中人员配备水平与再入院率之间的关系。
我们使用英格兰三个产科服务机构 2015 年至 2020 年期间收集的常规患者数据进行回顾性纵向研究。从医院管理系统中提取入院、出院和病例组合数据。在指数（分娩）入院的头两个 12 小时班次中，按每班次每患者每小时计算人员配备和工作量。将所有分娩入院的产后再入院和人员配备暴露情况输入分层多变量逻辑回归模型，以估计人员配备低于产科服务机构平均水平时的再入院概率。
64250 名产妇入院分娩，2903 名产妇在出院后 30 天内再次入院（4.5%）。三个服务机构的每名助产士的实际人员配备水平在 2.3 至 4.1 人之间。低于平均水平的助产士配备与产后 7 天内出院后的再入院率较高相关（调整后的比值比（aOR）1.108，95%CI 1.003 至 1.223）。对于出院后 30 天内的再入院，影响较小且无统计学意义（aOR 1.080，95%CI 0.994 至 1.174）。低于平均水平的助产学助手配备与产后再入院率较低相关（7 天 aOR 0.957，95%CI 0.867 至 1.057；30 天 aOR 0.965，95%CI 0.887 至 1.049，均无统计学意义）。
我们发现证据表明，低于预期的助产士人员配备水平与更多的产后再入院有关。这种关系的性质需要进一步调查，包括检查产妇人群中潜在的中介因素和再入院的原因。
