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Midwife ratios linked to readmission rates

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Maternity units with shortages of midwives are likely to have higher rates of readmission, UK nursing researchers have warned.

The findings come as the Royal College of Midwives continues to warn that the NHS in England needs 4,000 extra midwives.

The National Nursing Research Unit, based at King’s College London, found higher numbers of full-time equivalent midwives per birth were associated with a lower probability of readmission.

Additionally, a higher number of consultant midwives on a unit, compared to midwives, was also associated with fewer readmissions.

The study is the first time such analysis has been attempted for midwives and follows similar research showing higher registered nurse to patient ratios are linked to better outcomes.

The unit compared hospital episode data for 144 trusts that provide maternity care, for the period from April 2008 to March 2009, with information on staffing levels. In particular they focused on readmission rates within 28 days of birth to any hospital.

The authors said: “The results to date support assertions that adverse outcomes are potentially associated with lower midwifery staffing levels, with implications for the [government’s] current safety and quality of care policy agenda.”

They add: “Within a fixed budget, consideration is needed as to whether it is better to have higher numbers of more qualified and skilled staff but fewer staff overall, as opposed to more staff overall but fewer of the more highly qualified and skilled groups.”

However, the researchers acknowledged there was a “limitation to what can ultimately be learned” from looking at staffing levels without “consideration of the complex interactions involved” – for example, how staff should be deployed to maximise clinical and cost effectiveness.

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