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Labor Units of the Future: Physical Design and Standardization of Labor and Delivery Suites
Abstract Number: F-07
Abstract Type: Original Research
Standardization of equipment and processes are fundamental to safety in high stakes industries like aviation, aeronautics, nuclear power, and the military (1). Medicine has embraced standardization in the form of algorithms and checklists (2) but has yet to standardize equipment or physical layout of clinical areas. Facilities factors contribute to mortality in the high stakes, dynamic, multidisciplinary area of labor and delivery (3), but heterogeneity of physical design has not been previously studied. Therefore, the “optimal design” of a labor and delivery unit is unknown.
Between July 2015 and April 2016, academic and private labor and delivery units were measured in this prospective, observational, IRB-approved, pilot study. Researchers included a design expert, mechanical engineer, and clinicians who toured facilities and acquired direct measurements of labor rooms, OR’s, and other clinical areas. Configurations of medical equipment in rooms, square footage, and distances between resources were measured. When available, facility maps were combined with measurements using Computer-Aided-Design (CAD) software to facilitate data collection.
Data from the first four labor units is presented in Figure 1.Of note, multiple configurations of labor rooms and operating rooms existed within every institution measured. Clinical volume did not appear to correlate with labor room or operating room count. The distance between labor rooms and operating rooms varied within each institution The hospital in which patients recovered in their labor room had longer distances. Data from additional institutions will be presented at SOAP.
To our knowledge, this is the first pilot study demonstrating physical factor heterogeneity among labor and delivery units. Lack of standardization within an institution may contribute to provider, equipment, and patient safety issues. Lack of standardization across facilities may contribute to variation in practice and disparities in care. Further research is needed to determine the gold standard design for labor and delivery that maximizes efficiency, utilizes standardization to improve patient safety, and is tailored to the unique needs of individual units.
2. N Engl J Med 2013;368:246-253
3. CA-PAMR: 2002-2003 Maternal Death Reviews, 2011:47–9.