Busy day effect on the Finnish obstetric ecosystem

The quality improvement processes in health care began at the end of the 20th century. Hospitals were challenged to ensure and improve patient safety. In Finland, in the field of obstetrics, the delivery hospital ecosystem is going through a comprehensive reformation, which may, however, lead to unexpected busyness. Busyness may be associated with the quality of care, but evidence is lacking. In this study, delivery hospital level busy days were defined (Study I) and studied on selected process (study II) and outcome measures (studies III–IV) of obstetric care. Data was collected from Finnish Medical Birth Register, owned by the Institute of Health and Welfare. Data covered all live births and stillbirths with a birth weight ≥500g or gestational age ≥22 weeks. The total data consisted of N=634 810 hospital deliveries, between 2006 to 2016. Statistical analyses were conducted with adjusted logistic regression. In study I, the daily delivery volume variability was defined by calculating the arithmetic means for daily deliveries by hospital size (C1 50% of the mean to