title: [The relationship between system overload and adverse events in obstetric services].
abstract: BACKGROUND
  Adverse events occur throughout the medical system, and may lead to patient injury or even death. One of the difficulties in providing obstetric service is in predicting the medical complexity of cases and number of patients arriving in any given hour and in making sure that there is sufficient staff to cope around the clock.
  
  
  OBJECTIVE
  To examine the correlation between the occurrence of adverse events and the number of patients arriving at the delivery room or emergency obstetric services.
  
  
  OBJECTIVE
  We expected to find that the number of adverse events would increase during the day and during the night shift in direct relation to the number of births and patient arrivals to the maternity ward. Furthermore, we expected that there would be an increase in adverse events when less staff members were on duty.
  
  
  METHODS
  Retrospective data was collected from the risk management unit and from the delivery room of the Ha'Emek hospital in order to compare the number of patient arrivals and births with the adverse events reported in the period 2005-2006. In addition, data was collected on the total number of third and fourth degree perineal tears that occurred during delivery in 2005.
  
  
  RESULTS
  During the period 2005-2006 there were 8448 births. We found a significant difference in the rate of adverse events on different days of the week, between 6.6% -11.9% in every hundred births (0.05 > P). There was also a significant difference in adverse events between the night shift and the day shifts. The rate of third and fourth degree tearing of the perineum was higher during the night shift, 0.24%-0.83 % (p < 0.05).
  
  
  CONCLUSIONS
  The study raises the question as to whether the reason for the differences between the days of the week is related to the levels of reporting of different staff members. In addition, there appears to be a need for further investigation of the relationship between the number of adverse events on different days of the week and between the different shifts. The research was limited by the fact that data was collected retrospectively and only those adverse events which had been reported to the risk management unit by the maternity ward were examined.
authors: Department of Obstetrics & Gynecology, Ha'Emek Medical Center, Afula, Israel. lina_la@clalit.org.il
authors: Lina
authors: L
authors: Lauz
authors: Shabtai
authors: S
authors: Romano
authors: Eliezer
authors: E
authors: Shalev
mesh_terms: D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007557:Israel; D007744:Obstetric Labor Complications / Q000453:epidemiology*; D009775:Obstetrics and Gynecology Department, Hospital / Q000458:organization & administration / Q000706:statistics & numerical data*; D010502:Perineum / Q000293:injuries; D016012:Poisson Distribution; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D012308:Risk Management / Q000706:statistics & numerical data; D000078329:Workforce