1 Ariadne Labs, Boston, MA, USA.
2 MASS Design Group, Boston, MA, USA.
HERD. 2019 Apr;12(2):30-43. doi: 10.1177/1937586718796641. Epub 2018 Oct 3.
To assess the feasibility of quantifying variation in childbirth facility design and explore the implications for childbirth service delivery across the United States.
Design has been shown to impact quality of care in childbirth. However, most prior studies use qualitative data to examine associations between the design of patient rooms and patient experience. There has been limited exploration of measures of unit design and its impact on care provision.
We recruited 12 childbirth facilities that were diverse with regard to facility type, location, delivery volume, cesarean delivery rate, and practice model. Each facility provided annotated floor plans and participated in a site visit or telephone interview to provide information on their design and clinical practices. These data were analyzed with self-reported primary cesarean delivery rates to assess associations between design and care delivery.
We observed wide variation in childbirth unit design. Deliveries per labor room per year ranged from 75 to 479. The ratio of operating rooms to labor rooms ranged from 1:1 to 1:9. The average distance between labor rooms and workstations ranged from 23 to 114 ft, and the maximum distance between labor rooms ranged from 9 to 242 ft. More deliveries per room, fewer labor rooms per operating room, and longer distances between spaces were all associated with higher primary cesarean delivery rates.
Clinically relevant differences in design can be feasibly measured across diverse childbirth facilities. The design of these facilities may not be optimally matched to service delivery needs.
评估量化分娩设施设计差异的可行性，并探讨其对美国分娩服务提供的影响。
设计已被证明会影响分娩护理质量。然而，大多数先前的研究使用定性数据来检查病房设计与患者体验之间的关联。对于单位设计及其对护理提供的影响的衡量措施的探索有限。
我们招募了 12 家分娩设施，这些设施在设施类型、地理位置、分娩量、剖宫产率和实践模式方面存在差异。每家机构都提供了标注的平面图，并参与了现场访问或电话访谈，以提供其设计和临床实践的信息。这些数据与自我报告的主要剖宫产率进行了分析，以评估设计与护理提供之间的关联。
我们观察到分娩单元设计存在广泛差异。每个产房每年的分娩量从 75 到 479 不等。手术室与产房的比例从 1:1 到 1:9 不等。产房与工作站之间的平均距离从 23 到 114 英尺不等，最大距离从 9 到 242 英尺不等。每个房间的分娩量越多、每个手术室的产房越少、以及空间之间的距离越远，都与更高的主要剖宫产率相关。
可以在不同的分娩设施中切实可行地衡量设计方面的临床相关差异。这些设施的设计可能无法与服务提供需求最佳匹配。
