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Harefuah. 2011 Oct;150(10):774-7, 815.

[The relationship between system overload and adverse events in obstetric services].

[Article in Hebrew]

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Department of Obstetrics & Gynecology, Ha'Emek Medical Center, Afula, Israel.



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.


To examine the correlation between the occurrence of adverse events and the number of patients arriving at the delivery room or emergency obstetric services.


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.


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.


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).


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.

[Indexed for MEDLINE]
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