Measure to improve: is there a patient-acuity measurement tool suitable for use in maternity service provision in the Netherlands? A systematic review

Background and Aims It is difficult to overestimate the importance of safe staffing levels within the context of effective, quality healthcare. Poor staffing has been cited as a contributory factor in the number of unnecessary hospital deaths. This is particularly so in maternity care, where poor staffing has been inexorably linked to avoidable perinatal and maternal mortality. In the Netherlands, maternity service provision (MSP) is stratified into primary (community)- and secondary (hospital)-based care. While most midwives (71%) work in primary care, the majority are self-employed or work in small group practices. Where women birth at home, one-to-one care during labor is the norm. However, despite the existence of a national standard for birth-related care, which states unequivocally that women birthing in hospitals should (also) receive one-to-one care, while in labor this is not always the case. The extent of compliance with the national care standard has until now not been the subject of scrutiny. We aim to identify evidence for the use of patient-acuity measurement tools (PAMTs) in MSP to explore the extent of one-to-one care for women birthing in hospitals in the Netherlands and select and/or modify a valid PAMT suitable for use in maternity units in hospitals in the Netherlands to assess to what extent the quality standard of one-to-one care for birthing women is being met. Methods In this systematic literature review, all citations are first screened for title and abstract, then full text for suitability of inclusion. Results Three studies were identified for inclusion in the review. One PAMT is recommended. Conclusion One PAMT suitable for use in maternity service was identified. However, the evidence level for use is low. Nevertheless, in view of the unique nature of midwifery service provision, a PAMT specifically developed for use in maternity service is preferable