Analyzing the heterogeneity of labor and delivery units: A quantitative analysis of space and design

Abstract

This study assessed labor and delivery (L&D) unit space and design, and also considered correlations between physical space measurements and clinical outcomes. Design and human factors research has increased standardization in high-hazard industries, but is not fully utilized in medicine. Emergency department and intensive care unit space has been studied, but optimal L&D unit design is undefined. In this prospective, observational study, a multidisciplinary team assessed physical characteristics of ten L&D units. Design measurements were analyzed with California Maternal Quality Care Collaborative (CMQCC) data from 34,161 deliveries at these hospitals. The hospitals ranged in delivery volumes (<1000–>5000 annual deliveries) and cesarean section rates (19.6%-39.7%). Within and among units there was significant heterogeneity in labor room (LR) and operating room (OR) size, count, and number of configurations. There was significant homogeneity of room equipment. Delivery volumes correlated with unit size, room counts, and cesarean delivery rates. Relative risk of cesarean section was modestly increased when certain variables were above average (delivery volume, unit size, LR count, OR count, OR configuration count, LR to OR distance, unit utilization) or below average (LR size, OR size, LR configuration count). Existing variation suggests a gold standard design has yet to be adopted for L&D. A design-centered approach identified opportunities for standardization: 1) L&D unit size and 2) room counts based on current or projected delivery volume, and 3) LR and OR size and equipment. When combined with further human factors research, these guidelines could help design the L&D unit of the future.

Single-center task analysis and user-centered assessment of physical space impacts on emergency Cesarean delivery

“…Overall, our findings support existing evidence that the labor and delivery unit environment varies widely across the U.S. and that differences in design may impact care [ 7 , 8 , 36 , 37 ]. Testing different configurations of ORs and even entire labor and delivery units during actual and simulated obstetric emergencies would allow researchers to measure how design may impact performance and care delivery.…”

“…Previous research has found significant variation among existing hospitals in labor and delivery OR size and design layout despite similarities in equipment and processes [ 7 , 8 ]. This work suggests emergency Cesarean deliveries are performed in spaces designed based on available guidelines [ 9 – 11 ], building codes [ 12 ], and/or local constraints, but the spaces have not been fully optimized or standardized equivalently to spaces in other high-reliability organizations (e.g., cockpits in aviation, control rooms in nuclear power plants, etc.)…”

Understanding the Heterogeneity of Labor and Delivery Units: Using Design Thinking Methodology to Assess Environmental Factors that Contribute to Safety in Childbirth

“…Institutional refusal was the only exclusion criteria. 17 The institutional review board at the host institution approved the project protocol on July 13, 2015 and we have renewed every year since. We consented our participants by providing them with a research information sheet, allowing them a chance to read it over and ask questions before we embarked on the site visit.…”

“…We also interviewed a convenience sample of on-duty clinicians. While we made formal quantitative measurements, 17 we made the decision to keep our qualitative observations open-ended, unstructured, and observational and therefore did not follow formal interview guides. Because we were touring operational units with patients present, we did not record our interviews to ensure patients' privacy.…”

Ergonomic Challenges Inherent in Neonatal Resuscitation

“…These physical space requirements can prove inadequate when full maternal and neonatal resuscitation teams assemble in a delivery room. The impact of physical design on maternal clinical outcomes and patient safety is starting to be recognized, but the effect of space constraints on the performance of neonatal resuscitation teams and patient outcomes is yet to be considered [38,39,40]. As a result, the ideal physical design to optimize human performance is unknown at this time.…”