Common challenges managing bed and staff availability on labor and delivery units in the United States: A qualitative analysis

Plough, Avery; Henrich, Natalie; Galvin, Grace; Shah, Neel

doi:10.1111/birt.12342

Cited by 6 publications

(9 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Among a number of factors, optimal staffing for both physicians 38 and nurses 39 is critical for the provision of quality care. During weekends, hospitals are understaffed, 40 physicians are more likely to be less experienced, 41 and therefore, necessary interventions are often delayed 42 .…”

Section: Discussionmentioning

confidence: 99%

“…Studies that were conducted in the United States were consistent with the result of this study, indicating that weekend delivery in the United States is significantly associated with an increase in adverse outcomes. 8,12 Among a number of factors, optimal staffing for both physicians 38 and nurses 39 is critical for the provision of quality care. During weekends, hospitals are understaffed, 40 physicians are more likely to be less experienced, 41 and therefore, necessary interventions are often delayed.…”

Section: T a B L Ementioning

confidence: 99%

See 1 more Smart Citation

Weekend delivery and maternal–neonatal adverse outcomes in low‐risk pregnancies in the United States: A population‐based analysis of 3‐million live births

Kim

Selya

2022

Birth

View full text Add to dashboard Cite

Background Childbirth is the most common cause of hospital admission in the United States. Previous studies have shown that there might be a “weekend effect” in perinatal care, indicating that mothers and newborns whose deliveries occur during the weekends are at increased risk of having adverse outcomes. This study aims to isolate the association between the weekend delivery and maternal–neonatal adverse outcomes by investigating low‐risk pregnancies in nationwide data. Methods A population‐based study of all low‐risk pregnancies (in‐hospital, nonanomalous, term, normal birthweight, and singleton) was conducted based on US national natality data in 2017. Four maternal outcomes (ICU admission, uterine rupture, blood transfusion, and perineal laceration) and three neonatal outcomes (5‐minute Apgar <7, NICU admission, and neonatal death) were defined as adverse outcomes. Logistic regression analyses were conducted to determine the association, adjusting for 23 maternal and neonatal characteristics and risk factors. Results Among 3 011 577 low‐risk pregnancies, 6.0% were reported to have at least one of the maternal–neonatal adverse outcomes. Weekend deliveries were significantly associated with six maternal–neonatal adverse outcomes with an exception of neonatal death. In general, weekend deliveries were 1.13 times significantly as likely to have any of seven maternal–neonatal adverse outcomes than weekday deliveries (OR 1.13, 95% CI 1.11‐1.14), being attributed to adverse outcomes of more than 4500 mother–newborn pairs. Conclusions Weekend delivery is a consistent risk factor for both mothers and babies at the national level. Furthermore, studies are needed about possible modifiable factors that mediate these associations to ensure safe childbirth regardless of the day of delivery.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: T a B L Ementioning

confidence: 99%

Weekend delivery and maternal–neonatal adverse outcomes in low‐risk pregnancies in the United States: A population‐based analysis of 3‐million live births

Kim

Selya

2022

Birth

View full text Add to dashboard Cite

show abstract

“…During this phase, we conducted an extensive exploratory review of professional guidance, peer‐reviewed literature, and public quality improvement toolkits to understand the context of variation in obstetric outcomes in the United States. 3 , 4 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 We put particular emphasis on variation in hospital‐level cesarean birth rates based on broad stakeholder interest in the relationship between cesarean birth and value‐based care and precedent for cesarean as a proxy for quality of labor management. 20 , 21 We synthesized the broad range of strategies identified into higher‐level categories to consider targeting with our solution (eg, limiting cesareans for lack of progress in the latent phase, requiring a second opinion for intrapartum cesareans) and then developed a causation map of all potential strategies and the mechanisms through which they could affect cesarean birth rates.…”

Section: Methodsmentioning

confidence: 99%

“… 6 These failures may be because of, in part, clinical environments and care processes that are not well designed to support team‐based work. 7 , 8 , 9 Nonetheless, the science of designing, testing, and implementing care models that promote communication and teamwork remains nascent.…”

Section: Introductionmentioning

confidence: 99%

The design of “TeamBirth”: A care process to improve communication and teamwork during labor

Aggarwal

Plough

Henrich

et al. 2021

Birth

Self Cite

View full text Add to dashboard Cite

Background: Despite evidence that communication and teamwork are critical to patient safety, few care processes have been intentionally designed for this purpose in labor and delivery. The purpose of this project was to design an intrapartum care process that aims to improve communication and teamwork between clinicians and patients. Methods: We followed the "Double-Diamond" design method with four sequential steps: Discover, Define, Develop, and Deliver. In Discover, we searched professional guidelines and peer-reviewed literature to delineate the challenges to quality of intrapartum care and to uncover options for solutions. In Define, we convened an interdisciplinary group of experts to focus the problem scope and prioritize solution features. In Develop, we created initial prototype solutions. In Deliver, we engaged clinicians and patients in rapid cycle testing to iteratively produce a care process called "TeamBirth" that aims to improve team communication. Results: We designed TeamBirth, an intrapartum care process composed of brief team meetings ("huddles") between clinicians and patients. Huddles are navigated by a shared planning board placed in the labor and delivery room in view of the patient and their care team. The board promotes transparent and reliable communication and contains four areas to be acknowledged or discussed: (a) the names of the team members, starting with the patient; (b) the patient's preferences; (c) the care plan for the patient, baby, and labor progress; and (d) when the next team huddle is anticipated. Discussion: We identified an opportunity to improve the safety and dignity of childbirth care through an intrapartum care process that promotes reliable and structured communication and teamwork. Future work should evaluate the acceptability and feasibility of implementation and potential impact on safety and experience of care.

show abstract

“…Eight years ago, as members of Dr. Gawande's health system innovation center, we led an effort to close this gap, beginning with a user‐informed understanding of the design principles and requirements. We surveyed thousands of pregnant women about how they perceive hospital quality and interviewed hundreds of nurses, physicians, and midwives to characterize key differences in their care processes 10–12 . The solution that emerged was called “TeamBirth,” which relies on a dry‐erase whiteboard on the wall of the labor room to organize conversations between the delivering provider, the nurse, and, most importantly, the person in labor (Figure 2).…”

Section: Designing Teamwork In Childbirthmentioning

confidence: 99%

Why health care needs designers

Shah

Plough²

2022

Journal of Hospital Medicine

Self Cite

View full text Add to dashboard Cite

Common challenges managing bed and staff availability on labor and delivery units in the United States: A qualitative analysis

Abstract: Labor and delivery unit managers should distinctly assess both the proactiveness and systematicness of their existing management practices and consider how their practices could be modified to improve care.

Cited by 6 publications

References 33 publications

Weekend delivery and maternal–neonatal adverse outcomes in low‐risk pregnancies in the United States: A population‐based analysis of 3‐million live births

Weekend delivery and maternal–neonatal adverse outcomes in low‐risk pregnancies in the United States: A population‐based analysis of 3‐million live births

The design of “TeamBirth”: A care process to improve communication and teamwork during labor

Why health care needs designers

Contact Info

Product

Resources

About