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An Analysis of Labor Room Usage and Cesarean Section Rates on High Volume, High Acuity Obstetric Unit: Does Layout Matter?
Abstract Number: T-43
Abstract Type: Original Research
Introduction: The physical environment of a hospital can influence patient care (1-4). We hypothesized that proximity to operating room (OR) or nursing station is associated with labor and delivery room (LDR) utilization and intrapartum cesarean delivery rates at our high acuity, tertiary center with 10 LDRs and 3 ORs; [Figure 1A].
Methods: Electronic medical record data were reviewed for all women over 2.5 years. Cesarean delivery (CD) rates, vaginal delivery (VD) rates, and room utilization rates were calculated. Contingency table analysis was performed to determine differences in CD vs. VD rates amongst LDRs. Charge nurse interviews were conducted to determine room assignment preferences.
Results: Of 8,727 patients, 17.2% required intrapartum CD and 82.8% had VD. LDR utilization varied significantly (P < 0.001), with 36.1% of deliveries occurring in or from LDRs 5-7. Only 6.4% of all deliveries occurred in or from LDR 4. CD rates varied by LDR, with the highest rates occurring after labor in LDR’s 4, 9 and 10 (23.4%, 20.5% and 20.7%, respectively; [Fig 1B]).
Charge nurses preferred to admit women at higher risk of CD to LDRs 9 and 10 because of close proximity to OR and 4 because of negative air flow. LDRs 5-8 were preferably filled first given close proximity to nursing station. LDRs 1-3 were preferred for low risk women given furthest distance from monitoring station. These rooming preferences based on perceived risk correlated with significant differences in CD rate (Low risk rooms: 14.8%, normal risk: 16.5%, high risk: 21.5%).
Discussion: We found asymmetry in LDR use, CD rate, and rooming preferences. These results demonstrate 1) physical factors may be associated with resource utilization, and 2) charge nurses can stratify patient risk based on initial assessment. A rational future approach would incorporate these considerations and design a unit for stratification based on parturient risk.
This project was supported by grant P30HS023506 from the Agency for Healthcare Research & Quality. The content is solely the responsibility of the authors and does not necessarily represent official views of the AHRQ.
1. CA-PAMR: 2002 & 2003 Maternal Death Reviews. April 2011
2. Pati et al. AIA AAHF. 2009; 1-95
3. Gedey et al. Perkins + Will Research Journal 2014; (06.01):126-139