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Inpatient midwifery staffing levels and postpartum readmissions – a retrospective multi-centre longitudinal study

Inpatient midwifery staffing levels and postpartum readmissions – a retrospective multi-centre longitudinal study
Inpatient midwifery staffing levels and postpartum readmissions – a retrospective multi-centre longitudinal study
Background: 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.

Methods: 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.

Results: 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).

Conclusion: 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.
2044-6055
Turner, Lesley Yvonne
7c4a1fe5-21a1-4634-a1cc-0230322603d1
Saville, Christina
2c726abd-1604-458c-bc0b-daeef1b084bd
Ball, Jane
85ac7d7a-b21e-42fd-858b-78d263c559c1
Culliford, David
25511573-74d3-422a-b0ee-dfe60f80df87
Dall'Ora, Chiara
4501b172-005c-4fad-86da-2d63978ffdfd
Jones, Jeremy
270b303b-6bad-4be7-8ea0-63d0e8015c91
Kitson-Reynolds, Ellen
28b0a1aa-6f3c-4fed-bf0a-456fe5f5ca73
Meredith, Paul
652fc110-7cba-48c3-bfba-264c43324626
Griffiths, Peter
ac7afec1-7d72-4b83-b016-3a43e245265b
Turner, Lesley Yvonne
7c4a1fe5-21a1-4634-a1cc-0230322603d1
Saville, Christina
2c726abd-1604-458c-bc0b-daeef1b084bd
Ball, Jane
85ac7d7a-b21e-42fd-858b-78d263c559c1
Culliford, David
25511573-74d3-422a-b0ee-dfe60f80df87
Dall'Ora, Chiara
4501b172-005c-4fad-86da-2d63978ffdfd
Jones, Jeremy
270b303b-6bad-4be7-8ea0-63d0e8015c91
Kitson-Reynolds, Ellen
28b0a1aa-6f3c-4fed-bf0a-456fe5f5ca73
Meredith, Paul
652fc110-7cba-48c3-bfba-264c43324626
Griffiths, Peter
ac7afec1-7d72-4b83-b016-3a43e245265b

Turner, Lesley Yvonne, Saville, Christina, Ball, Jane, Culliford, David, Dall'Ora, Chiara, Jones, Jeremy, Kitson-Reynolds, Ellen, Meredith, Paul and Griffiths, Peter (2024) Inpatient midwifery staffing levels and postpartum readmissions – a retrospective multi-centre longitudinal study. BMJ Open, 14 (4), [e077710]. (doi:10.1136/bmjopen-2023-077710).

Record type: Article

Abstract

Background: 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.

Methods: 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.

Results: 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).

Conclusion: 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.

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Accepted/In Press date: 13 March 2024
e-pub ahead of print date: 3 April 2024
Published date: 3 April 2024
Additional Information: For the purpose of open access, the author has applied a Creative Commons attribution license (CC BY) to any Author Accepted Manuscript version arising from this submission. Publisher Copyright: © Author(s) (or their employer(s)) 2024.

Identifiers

Local EPrints ID: 489126
URI: http://eprints.soton.ac.uk/id/eprint/489126
ISSN: 2044-6055
PURE UUID: dfe52836-9dd5-418c-b4a8-15a143c57cf6
ORCID for Lesley Yvonne Turner: ORCID iD orcid.org/0000-0003-1489-3471
ORCID for Christina Saville: ORCID iD orcid.org/0000-0001-7718-5689
ORCID for Jane Ball: ORCID iD orcid.org/0000-0002-8655-2994
ORCID for David Culliford: ORCID iD orcid.org/0000-0003-1663-0253
ORCID for Chiara Dall'Ora: ORCID iD orcid.org/0000-0002-6858-3535
ORCID for Ellen Kitson-Reynolds: ORCID iD orcid.org/0000-0002-8099-883X
ORCID for Paul Meredith: ORCID iD orcid.org/0000-0002-5464-371X
ORCID for Peter Griffiths: ORCID iD orcid.org/0000-0003-2439-2857

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Date deposited: 15 Apr 2024 16:42
Last modified: 21 May 2024 02:02

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Contributors

Author: Jane Ball ORCID iD
Author: David Culliford ORCID iD
Author: Chiara Dall'Ora ORCID iD
Author: Jeremy Jones
Author: Paul Meredith ORCID iD
Author: Peter Griffiths ORCID iD

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