title: Relationship of Hospital Staff Coverage and Delivery Room Resuscitation Practices to Birth Asphyxia.
abstract: ObjectiveThe objective of this study was to assess utilization of specialist coverage and checklists in perinatal settings and to examine utilization by birth asphyxia rates.DesignThis is a survey study of California maternity hospitals concerning checklist use to prepare for delivery room resuscitation and 24-hour in-house specialist coverage (pediatrician/neonatologist, obstetrician, and obstetric anesthesiologist) and results linked to hospital birth asphyxia rates (preterm and low weight births were excluded).ResultsOf 253 maternity hospitals, 138 responded (55%); 59 (43%) indicated checklist use, and in-house specialist coverage ranged from 38% (pediatrician/neonatologist) to 54% (anesthesiology). In-house coverage was more common in urban versus rural hospitals for all specialties (p< 0.0001), but checklist use was not significantly different (p= 0.88). Higher birth volume hospitals had more specialist coverage (p< 0.0001), whereas checklist use did not differ (p= 0.3). In-house obstetric coverage was associated with lower asphyxia rates (odds ratio: 0.34; 95% confidence interval [CI]: 0.20, 0.58) in a regression model accounting for other providers. Checklist use was not associated with birth asphyxia (odds ratio: 1.12; 95% CI: 0.75, 1.68).ConclusionHigher birth volume and urban hospitals demonstrated greater in-house specialist coverage, but checklist use was similar across all hospitals. Current data suggest that in-house obstetric coverage has greater impact on asphyxia than other specialist coverage or checklist use.
authors.affiliation: College of Physicians and Surgeons, Columbia University, New York, New York.
authors.forename: Joanna H
authors.initials: JH
authors.lastname: Tu
authors.affiliation: Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University, Stanford, California.
authors.forename: Jochen
authors.initials: J
authors.lastname: Profit
authors.affiliation: California Maternal Quality Care Collaborative, Stanford, California.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Melsop
authors.affiliation: Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University, Stanford, California.
authors.forename: Taylor
authors.initials: T
authors.lastname: Brown
authors.affiliation: Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University, Stanford, California.
authors.forename: Alexis
authors.initials: A
authors.lastname: Davis
authors.affiliation: California Maternal Quality Care Collaborative, Stanford, California.
authors.forename: Elliot
authors.initials: E
authors.lastname: Main
authors.affiliation: Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University, Stanford, California.
authors.forename: Henry C
authors.initials: HC
authors.lastname: Lee
mesh_terms: D000776:Anesthesiology; D001238:Asphyxia Neonatorum / Q000628:therapy*; D002140:California; D057189:Checklist / Q000706:statistics & numerical data; D003696:Delivery Rooms; D061847:Hospitals, High-Volume; D006771:Hospitals, Maternity; D006780:Hospitals, Rural; D006786:Hospitals, Urban; D006801:Humans; D007231:Infant, Newborn; D008505:Medical Staff, Hospital / Q000600:supply & distribution*; D009359:Neonatology; D009774:Obstetrics; D010372:Pediatrics; D012151:Resuscitation; D013038:Specialization; D011795:Surveys and Questionnaires; D000078329:Workforce