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Obstetrical & Gynecological Survey:
doi: 10.1097/01.ogx.0000445772.29673.3e
Obstetrics: Ethics, Medicolegal Issues, and Public Policy

The Size of the Labor Wards: Is Bigger Better When It Comes to Patient Safety?

Milland, Maria; Christoffersen, Jens K.; Hedegaard, Morten

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Abstract

ABSTRACT: Obstetric injuries due to medical errors are rare, but their consequences may be severe or fatal. Since 1995, the Danish Patient Insurance Association (DPIA) has recognized a fairly constant number of ∼30 obstetric claims per year. This retrospective study was undertaken to assess possible associations between the size of labor units and the frequency of approved obstetric claims.

The DPIA database was used to identify submitted obstetric claims where the suspected injury occurred between 1995 and 2009. In the 1440 cases reviewed, the main outcome measure was whether the claim had been approved by the DPIA. After exclusion of cases for various reasons, 1326 were included in the final analysis. The 29 labor units were categorized based on the average annual number of deliveries during the study period: 4 small labor units with less than 1000 deliveries per year, 19 intermediate size units with 1000 to 2999 deliveries per year, 4 large labor units with 3000 to 3999 deliveries per year, and 2 very large units with 4000 or more deliveries per year. Statistical analysis was performed in SPSS version 18.0 for Windows. The χ2 tests (including test for trend) were used for comparisons.

The overall frequency of submitted claims per number of deliveries was 1.5 per thousand. No significant difference was found between size of unit and rate of claim submissions. Of the 1326 claims, 527 (39.7%) were approved; 145 (28%) of approved claims did not receive any financial compensation despite acknowledgement of obstetric error by the DPIA. The submitted claims regarding injuries occurring in small labor units had the highest approval rate (50.0%, n = 30), followed by intermediate units (41.7%, n = 306) and very large units (38.8%, n = 76). Large units with 3000 to 3999 deliveries annually had the lowest approval rate (34.2%, n = 115; P < 0.05). The overall rate of approved claims per number of deliveries was 0.6 per thousand. Among the 29 labor units, the number of approved claims per number of deliveries ranged from 0.3 to 1.8 per thousand (P < 0.01).

Large labor units seem to meet the best practices principles that were used to approve or deny obstetric claims more frequently than smaller or very large units. Most approved obstetric claims were based on what having an experienced clinician involved with the care would have offered, particularly in smaller labor units. This was assumed to be related to the reduced availability of in-house obstetricians and poorer representation of auxiliary services.

© 2014 by Lippincott Williams & Wilkins.

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