Differences in obstetric care and outcomes associated with proportion of obstetrician shift completed.

ABSTRACT Background Understanding and improving obstetric 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 attempted to improve the quality of care provided to obstetric patients. Although many factors contribute to delivery decisions, less work has addressed how provider issues such as fatigue or behaviors surrounding impending changes in shift may influence delivery mode and outcomes. Objective The objective was assess whether intrapartum obstetric interventions and adverse outcomes differ based on temporal proximity of delivery to attending shift change. Methods This was a secondary analysis from a multicenter obstetric 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 provider to their shift change and a delivery intervention was a ratio of (time from most recent attending shift change to vaginal delivery or decision for cesarean delivery) over (total length of shift). Ratios were used to represent the proportion of time completed in the shift, while standardizing for varying shift lengths. A sensitivity analysis restricted to patients delivered by physicians working 12-hour shifts was performed. Outcomes chosen included cesarean delivery, episiotomy, 3rd or 4th degree perineal laceration, 5-minute Apgar score Results Of 82,851 patients eligible for inclusion, 47,262 (57%) had available ratio data 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, 3rd or4th degree perineal laceration, or 5-minute Apgar score Conclusions Clinically significant differences in obstetric interventions and outcomes do not appear to exist based on temporal proximity to attending physician shift change. Future work should attempt to directly study unit culture and provider fatigue in order to further investigate opportunities to improve obstetric quality of care, and additional studies are needed to corroborate these findings in community settings.