An Examination of Throughput Issues in Inpatient Obstetrics Units in an Academic Medical Center

To examine evidence of throughput from the electronic health record (EHR) and compare it to the bedside experts' perceptions to determine throughput metrics for inpatient obstetric (OB) units, determine staff perceptions of throughput, and compare throughput and staff perception to make informed recommendations to improve throughput.

This quality improvement project was a comparative analysis of variables, including time/day/shift, unit volumes, and staff perceptions of barriers and enhancers, to determine the relationship to patient throughput.

The project was conducted at an inpatient academic medical center, specifically within the OB units, including labor and delivery (L&D) and mother-infant unit (MIU). Record-high birth volumes and unchanged bed capacity highlighted throughput concerns.

Participants were the employees from L&D or MIU who voluntarily completed the anonymous survey during a 30-day period, excluding nurse leadership and floating staff. The retrospective throughput EHR data were from a convenience sample of patients admitted and transferred to MIU during a 30-day period, excluding patients who did not transfer or were not postpartum.

Data metrics included times for specific events (birth, ready to transfer, arrival at MIU, discharge, room clean turnover, patient transport) and daily census (volume) over a month.

Census increases had significant relationships with throughput metrics in OB units. Results indicated that removing barriers by optimizing scheduling, enhancing staffing, using acuity-based ratios, and improving the transfer protocol should be the initial quality improvement interventions for throughput.

Efforts to standardize care to enhance the efficiency and safety of throughput between inpatient OB units requires identification of constraints on personnel as well as analysis of objective data from the EHR. Priority should be placed on understanding staffing, acuity ratios, and volumes/available beds to improve patient flow in a manner that benefits both patients and staff.