Impact of the absence of hospital staff obstetricians on method of delivery, severe maternal and perinatal morbidity in a type 2 maternity ward

Temporary work is routinely used in the hospital environment to address occasional and short-term needs. The need for locum doctors is increasing steadily in France due to the increase in the statutory vacancy rate of hospital practitioners, reaching 29.1% in 2019 with a progression of 1.7% in one year [1]. This rate is defined as the percentage of vacant positions resulting from the gap between the number of permanent positions of budgeted hospital practitioners and the number of full-time and part-time hospital staff practitioners and those in a paid probation period. The number of regions with a statutory vacancy rate greater than or equal to 30% increased from 3 in 2018 to 7 in 2019 [2]. In 2019, Normandy had 36.9% positions of full-time hospital practitioners vacant in all specialties, an increase of 2% in one year. At the national level, annual charges related to temporary medical staff increased by an average of 10% between 2011 and 2014. The trend does not appear to decrease, as intermittent activity (mainly represented by that of the locum doctors) increased by 37% between 2010 and 2018 [3].

The use of locum doctors is preferred to resolve temporary difficulties [4]. Several doctors may take turns to fill the vacancy left by a staff practitioner who has resigned or retired. This is especially true for specialties under pressure that require continuous care such as anaesthesia-resuscitation, radiology, emergency medicine, obstetrics-gynaecology, or paediatrics [4]. Regarding obstetrics, the functioning of delivery rooms requires the regular hiring of locum doctors. After successive departures of hospital practitioners, some maternity wards can only maintain their continuity of care at the cost of a massive recruitment of temporary obstetricians.

There is often much criticism of the unregulated use of this practice. This is due to the significant additional cost of these recruitments, but also because of the quality and safety of care provided [4]. Questions about professional skills, but more often the fact that these temporary assignments do not promote patient follow-up, nor knowledge of procedures, mastery of computer software, or adherence to the institution's medical guidelines [5]. As a result, the continued turnover of practitioners increases the workload and strain on staff healthcare teams, increasing the risk of inadequate care [6]. The various studies on the subject do not appear to reveal any significant increase in morbidity or mortality associated with the hiring of locum doctors in general medicine, anaesthesia, hospital medicine or neurosurgery [7], [8], [9], [10], [11]. Obstetric findings are unknown although regular use of locum obstetricians may impact quality of care and adverse events [6].

The primary objective of our study was to assess the impact of the absence of a hospital staff obstetrician on the method of delivery in a type 2 maternity ward between the year 2017 before the departure of staff, and 2019 after their departure. The secondary objective was to compare severe maternal and perinatal morbidities during this same period.

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