The aim of measuring quality is to improve quality. Through measurement, we learn which hospitals have the best outcomes and can study the processes that help the hospital to achieve these good outcomes. In this issue of BJOG, PyyOnen et al. present work examining differences in outcomes for low-risk term pregnancies in Finland. They show that the size of the hospital is associated with differences in neonatal outcomes. Interestingly, good outcomes are not concentrated in small or large hospitals. Instead, low-volume hospitals show better outcomes in some areas (pH < 7.10 and Apgar < 4 at 5 minutes), whereas large hospitals show less obstetric trauma, fractured clavicles and Erb's palsies. The processes that lead to the various neonatal outcomes studied by Pyyonen et al. are not the same. For example, the rapid and safe relief of a shoulder dystocia without incurring a neonatal injury does not require the same skill set as judging when a fetus is intolerant of labour and requires expedited delivery. There is no reason to believe that, because an institution is good at one of these skills, it will be good at both. Furthermore, there may be systematic reasons why these skill sets and organisational resources might be better at one hospital than another. As the authors speculate, perhaps large hospitals have more opportunities to perform shoulder dystocia manoeuvres and thus, on the whole, are better at them. The link between procedure outcomes and hospital volumes has been shown in other areas of medicine (Birkmeyer et al. N Engl J Med 2002;346:l 128-37). Alternatively, in smaller hospitals with few staff members, one could speculate that the need for more lead time to gather the multidisciplinary team necessary for a caesarean section may require more situa-tional awareness and attention to the fetal monitor. Thus, the need for proactive lead time to gather a team may result in more attention paid to the subtle signs of trouble.
展开▼
机译：衡量质量的目的是提高质量。通过测量，我们了解哪些医院效果最佳，并且可以研究有助于医院实现这些良好效果的过程。在本期BJOG中，PyyOnen等人。目前研究芬兰低危足月妊娠结局差异的工作。他们表明，医院规模与新生儿结局的差异有关。有趣的是，好的结果并不集中在小型或大型医院。取而代之的是，小规模的医院在某些地区（pH <7.10，5分钟时的Apgar <4）显示出更好的结果，而大型医院的产科创伤，锁骨骨折和Erb麻痹较少。 Pyyonen等人研究了导致各种新生儿结局的过程。不一样。例如，在不引起新生儿伤害的情况下快速安全地缓解肩难产，不需要与判断胎儿不能忍受分娩并需要快速分娩的判断技能相同的技能。没有理由相信，因为一个机构擅长这两种技能中的一种，所以它将同时具备这两种技能。此外，可能有系统的原因导致这些技能和组织资源在一家医院可能比另一家更好。正如作者所推测的那样，也许大型医院有更多机会进行肩难产手术，因此，总体上来说，他们做得更好。程序结果与医院容量之间的联系已经在其他医学领域得到了证明（Birkmeyer等人，N Engl J Med 2002; 346：112-37）。另外，在工作人员很少的小型医院中，人们可能会认为需要更多的准备时间来收集剖宫产所需的多学科团队，这可能需要更多的情境意识和对胎儿监护仪的关注。因此，需要提前准备时间来组建团队可能会导致更多地关注麻烦的细微迹象。
展开▼
