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Quality of outcome and cost in an obstetric and neonatal service.

A review has been made of the outcome and efficiency of the obstetric and neonatal service, St Helen's Hospital, Auckland. In the last seven years there has been a 33% fall in perinatal mortality rates to 5.88 per 1000 births in 1987. The average perinatal death rate for Maori infants was low, 4.81 per 1000 compared to 7.43 per 1000 for Europeans over this period. There has been a 38% increase in births to 3597 a year while the total hospital staffing has only risen 9%. Thus the ratio of births to staff has increased by 26.6% to 15.6. The cost per infant delivered in constant dollars has fallen 18.7% in the same period to $2432. The postnatal bed occupancy was 101% in 1987 and the average day stay fell to 5.7 days. An extra 61 full time staff would be needed to reduce the workload to that of 1981 and the staff is now unable to give the family focused holistic care that is needed.