Plough Avery, Henrich Natalie, Galvin Grace, Shah Neel T
Ariadne Labs at Brigham and Women's Hospital and the Harvard T.H, Chan School of Public Health, Boston, MA, USA.
Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Birth. 2018 Sep;45(3):303-310. doi: 10.1111/birt.12342. Epub 2018 Feb 24.
Managers of labor and delivery units need to ensure that their limited supply of beds and nursing staff are adequately available, despite uncertainty with respect to patient needs. The ability to address this challenge has been associated with patient outcomes; however, best practices have not been defined.
We conducted a secondary analysis of 96 interviews with nurse and physician managers from 48 labor and delivery units across the United States. Included units represented a diverse range of characteristics, but skewed toward higher volume teaching hospitals. The prior study scored management practice based on their proactiveness (ability to mitigate challenges before they occur). Based on emerging themes, we identified common challenges in managing bed and staff availability and performed an analysis of positive deviants to identify an additional criterion for effective management performance.
We identified four key challenges common to all labor and delivery units, (1) scheduling planned cases, (2) tracking patient flow, (3) monitoring bed and staff availability in the moment, and (4) adjusting bed and staff availability in the moment. We also identified "systematicness" (ability to address challenges in a consistent and reliable manner) as an emerging criterion for effective management. We observed that being proactive and systematic represented distinct characteristics, and units with both proactive and systematic practices appeared best positioned to effectively manage limited beds and staffing.
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.
产房的管理人员需要确保，尽管患者需求存在不确定性，但有限的床位供应和护理人员能够充分满足需求。应对这一挑战的能力与患者的治疗结果相关；然而，尚未明确最佳实践方法。
我们对来自美国48个产房的护士和医生管理人员进行的96次访谈进行了二次分析。纳入的产房具有广泛的特征，但偏向于高容量的教学医院。先前的研究根据管理实践的前瞻性（在挑战发生之前减轻其影响的能力）对其进行评分。基于新出现的主题，我们确定了管理床位和人员供应方面的常见挑战，并对表现优异的单位进行了分析，以确定有效管理绩效的额外标准。
我们确定了所有产房共有的四个关键挑战：（1）安排计划内的病例；（2）跟踪患者流量；（3）实时监测床位和人员供应情况；（4）实时调整床位和人员供应情况。我们还确定了“系统性”（以一致且可靠的方式应对挑战的能力）作为有效管理的一个新出现的标准。我们观察到，积极主动和具备系统性代表了不同的特征，同时具备积极主动和系统性做法的产房似乎最有能力有效管理有限的床位和人员配备。
产房管理人员应分别评估其现有管理实践的前瞻性和系统性，并考虑如何改进其做法以提高护理质量。
