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Association Between Labor and Delivery Unit Census and Delays in Patient Management: Findings From a Computer

Rose L Molina1, Matthew Gombolay, Jennifer Jonas

  • 1Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, Massachusetts; the School of Interactive Computing, Georgia Institute of Technology, Atlanta, Georgia; Albert Einstein College of Medicine, New York, New York; and the Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Cambridge, Massachusetts.

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Increased patient volume in labor and delivery units leads to care delays. A computer simulation showed higher census correlated with longer decision times and patient transfers, impacting care quality.

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Area of Science:

  • Healthcare Management
  • Clinical Operations
  • Patient Flow Optimization

Background:

  • Labor and delivery unit census fluctuations can impact patient care.
  • Efficient resource allocation is critical in high-acuity settings.

Purpose of the Study:

  • To investigate the association between increased labor and delivery unit census and patient care decision delays.
  • To validate computer simulation as a tool for assessing care sensitivity to patient volume.

Main Methods:

  • Observational cohort study using a computer simulation module mirroring a tertiary care academic medical center's labor and delivery unit.
  • Nurse managers (n=13) made dynamic staffing and bed allocation decisions during simulated 12-hour shifts with varying patient census.
  • Mixed logistic and linear regression models analyzed associations between patient census and decision delays.

Main Results:

  • Each additional patient on the unit increased odds of recommending ambulation by 47%.
  • Each additional patient on the unit delayed delivery-to-postpartum transfer by 15.9 minutes.
  • Each additional patient in the waiting room delayed waiting room time by 33.3 minutes and cesarean delivery OR transfer by 14.3 minutes.

Conclusions:

  • Increasing labor and delivery unit census is significantly associated with patient care delays.
  • Computer simulation effectively demonstrates the impact of patient volume on clinical decision-making and care delivery.