Maternal-Fetal Medicine Units Network Cesarean Registry: impact of shift change on cesarean complications

Jennifer L. Bailit; Mark B. Landon; Yinglei Lai; Dwight J. Rouse; Catherine Y. Spong; Michael W. Varner; Atef H. Moawad; Hyagriv N. Simhan; Margaret Harper; Ronald J. Wapner; Yoram Sorokin; Menachem Miodovnik; Mary Jo O'Sullivan; Baha M. Sibai; Oded Langer

doi:10.1016/j.ajog.2007.11.003

Maternal-Fetal Medicine Units Network Cesarean Registry: impact of shift change on cesarean complications

Jennifer L. Bailit, Mark B. Landon, Yinglei Lai, Dwight J. Rouse, Catherine Y. Spong, Michael W. Varner, Atef H. Moawad, Hyagriv N. Simhan, Margaret Harper, Ronald J. Wapner, Yoram Sorokin, Menachem Miodovnik, Mary Jo O'Sullivan, Baha M. Sibai, Oded Langer

Research output: Contribution to journal › Article › peer-review

22 Scopus citations

Abstract

Objective: This study was undertaken to evaluate the effect of change of shift for physicians and nurses on complications associated with cesarean delivery. Study Design: 17,996 term women undergoing an unscheduled cesarean delivery in 13 centers from 1999-2000 were included. Maternal and neonatal morbidities were evaluated by time of infant delivery vis-à-vis nursing change of shift (6 am-8 am, 2 pm-4 pm, 10 pm-12 am vs all other hours). The sample was then limited to weekdays only and physician shift changes were evaluated (physician shift change 6 am-8 am, 5 pm-7 pm vs all others). A composite of 30 maternal morbidities was also evaluated by logistic regression, controlling for potentially confounding factors. Results: Physician change of shift had no measurable effect on maternal and neonatal outcomes. Neonatal facial nerve palsies were increased at nursing change of shift (5 vs 0) as were hysterectomies (33 [0.24%] vs 23 [0.53%]; P < .007). Nursing change of shift had no impact on composite maternal morbidity after controlling for age, race, insurance, medical problems, prior incision type, weekend day, and prenatal care (odds ratio = 0.98; 95% confidence interval = 0.89-1.08). Conclusion: Physician change of shift does not appear to be associated with an increase in morbidities. However, cesarean delivery during nursing change of shift is associated with increased risk of neonatal facial nerve palsy and hysterectomy. Further investigation is needed to understand the cause of this association.

Original language	English (US)
Pages (from-to)	173.e1-173.e5
Journal	American journal of obstetrics and gynecology
Volume	198
Issue number	2
DOIs	https://doi.org/10.1016/j.ajog.2007.11.003
State	Published - Feb 2008
Externally published	Yes

Keywords

change of shift
obstetrics
quality of care
work hours

ASJC Scopus subject areas

Obstetrics and Gynecology

Access to Document

10.1016/j.ajog.2007.11.003

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Bailit, J. L., Landon, M. B., Lai, Y., Rouse, D. J., Spong, C. Y., Varner, M. W., Moawad, A. H., Simhan, H. N., Harper, M., Wapner, R. J., Sorokin, Y., Miodovnik, M., O'Sullivan, M. J., Sibai, B. M., & Langer, O. (2008). Maternal-Fetal Medicine Units Network Cesarean Registry: impact of shift change on cesarean complications. American journal of obstetrics and gynecology, 198(2), 173.e1-173.e5. https://doi.org/10.1016/j.ajog.2007.11.003

Bailit, JL, Landon, MB, Lai, Y, Rouse, DJ, Spong, CY, Varner, MW, Moawad, AH, Simhan, HN, Harper, M, Wapner, RJ, Sorokin, Y, Miodovnik, M, O'Sullivan, MJ, Sibai, BM & Langer, O 2008, 'Maternal-Fetal Medicine Units Network Cesarean Registry: impact of shift change on cesarean complications', American journal of obstetrics and gynecology, vol. 198, no. 2, pp. 173.e1-173.e5. https://doi.org/10.1016/j.ajog.2007.11.003

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title = "Maternal-Fetal Medicine Units Network Cesarean Registry: impact of shift change on cesarean complications",

abstract = "Objective: This study was undertaken to evaluate the effect of change of shift for physicians and nurses on complications associated with cesarean delivery. Study Design: 17,996 term women undergoing an unscheduled cesarean delivery in 13 centers from 1999-2000 were included. Maternal and neonatal morbidities were evaluated by time of infant delivery vis-{\`a}-vis nursing change of shift (6 am-8 am, 2 pm-4 pm, 10 pm-12 am vs all other hours). The sample was then limited to weekdays only and physician shift changes were evaluated (physician shift change 6 am-8 am, 5 pm-7 pm vs all others). A composite of 30 maternal morbidities was also evaluated by logistic regression, controlling for potentially confounding factors. Results: Physician change of shift had no measurable effect on maternal and neonatal outcomes. Neonatal facial nerve palsies were increased at nursing change of shift (5 vs 0) as were hysterectomies (33 [0.24%] vs 23 [0.53%]; P < .007). Nursing change of shift had no impact on composite maternal morbidity after controlling for age, race, insurance, medical problems, prior incision type, weekend day, and prenatal care (odds ratio = 0.98; 95% confidence interval = 0.89-1.08). Conclusion: Physician change of shift does not appear to be associated with an increase in morbidities. However, cesarean delivery during nursing change of shift is associated with increased risk of neonatal facial nerve palsy and hysterectomy. Further investigation is needed to understand the cause of this association.",

keywords = "change of shift, obstetrics, quality of care, work hours",

author = "Bailit, {Jennifer L.} and Landon, {Mark B.} and Yinglei Lai and Rouse, {Dwight J.} and Spong, {Catherine Y.} and Varner, {Michael W.} and Moawad, {Atef H.} and Simhan, {Hyagriv N.} and Margaret Harper and Wapner, {Ronald J.} and Yoram Sorokin and Menachem Miodovnik and O'Sullivan, {Mary Jo} and Sibai, {Baha M.} and Oded Langer",

note = "Funding Information: This study is supported by the Women{\textquoteright}s Reproductive Health Research Career Development Program K12, grant HD98004 (J.L.B.), and grants HD21410, HD21414, HD27860, HD27861, HD27869, HD27905, HD27915, HD27917, HD34116, HD34122, HD34136, HD34208, HD34210, and HD36801 from the National Institute of Child Health and Human Development. ",

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doi = "10.1016/j.ajog.2007.11.003",

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T1 - Maternal-Fetal Medicine Units Network Cesarean Registry

T2 - impact of shift change on cesarean complications

AU - Bailit, Jennifer L.

AU - Landon, Mark B.

AU - Lai, Yinglei

AU - Rouse, Dwight J.

AU - Spong, Catherine Y.

AU - Varner, Michael W.

AU - Moawad, Atef H.

AU - Simhan, Hyagriv N.

AU - Harper, Margaret

AU - Wapner, Ronald J.

AU - Sorokin, Yoram

AU - Miodovnik, Menachem

AU - O'Sullivan, Mary Jo

AU - Sibai, Baha M.

AU - Langer, Oded

N1 - Funding Information: This study is supported by the Women’s Reproductive Health Research Career Development Program K12, grant HD98004 (J.L.B.), and grants HD21410, HD21414, HD27860, HD27861, HD27869, HD27905, HD27915, HD27917, HD34116, HD34122, HD34136, HD34208, HD34210, and HD36801 from the National Institute of Child Health and Human Development.

PY - 2008/2

Y1 - 2008/2

N2 - Objective: This study was undertaken to evaluate the effect of change of shift for physicians and nurses on complications associated with cesarean delivery. Study Design: 17,996 term women undergoing an unscheduled cesarean delivery in 13 centers from 1999-2000 were included. Maternal and neonatal morbidities were evaluated by time of infant delivery vis-à-vis nursing change of shift (6 am-8 am, 2 pm-4 pm, 10 pm-12 am vs all other hours). The sample was then limited to weekdays only and physician shift changes were evaluated (physician shift change 6 am-8 am, 5 pm-7 pm vs all others). A composite of 30 maternal morbidities was also evaluated by logistic regression, controlling for potentially confounding factors. Results: Physician change of shift had no measurable effect on maternal and neonatal outcomes. Neonatal facial nerve palsies were increased at nursing change of shift (5 vs 0) as were hysterectomies (33 [0.24%] vs 23 [0.53%]; P < .007). Nursing change of shift had no impact on composite maternal morbidity after controlling for age, race, insurance, medical problems, prior incision type, weekend day, and prenatal care (odds ratio = 0.98; 95% confidence interval = 0.89-1.08). Conclusion: Physician change of shift does not appear to be associated with an increase in morbidities. However, cesarean delivery during nursing change of shift is associated with increased risk of neonatal facial nerve palsy and hysterectomy. Further investigation is needed to understand the cause of this association.

AB - Objective: This study was undertaken to evaluate the effect of change of shift for physicians and nurses on complications associated with cesarean delivery. Study Design: 17,996 term women undergoing an unscheduled cesarean delivery in 13 centers from 1999-2000 were included. Maternal and neonatal morbidities were evaluated by time of infant delivery vis-à-vis nursing change of shift (6 am-8 am, 2 pm-4 pm, 10 pm-12 am vs all other hours). The sample was then limited to weekdays only and physician shift changes were evaluated (physician shift change 6 am-8 am, 5 pm-7 pm vs all others). A composite of 30 maternal morbidities was also evaluated by logistic regression, controlling for potentially confounding factors. Results: Physician change of shift had no measurable effect on maternal and neonatal outcomes. Neonatal facial nerve palsies were increased at nursing change of shift (5 vs 0) as were hysterectomies (33 [0.24%] vs 23 [0.53%]; P < .007). Nursing change of shift had no impact on composite maternal morbidity after controlling for age, race, insurance, medical problems, prior incision type, weekend day, and prenatal care (odds ratio = 0.98; 95% confidence interval = 0.89-1.08). Conclusion: Physician change of shift does not appear to be associated with an increase in morbidities. However, cesarean delivery during nursing change of shift is associated with increased risk of neonatal facial nerve palsy and hysterectomy. Further investigation is needed to understand the cause of this association.

KW - change of shift

KW - obstetrics

KW - quality of care

KW - work hours

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Maternal-Fetal Medicine Units Network Cesarean Registry: impact of shift change on cesarean complications

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