Measuring Variation in Design Among American Childbirth Facilities [11R

Abstract

INTRODUCTION: Facility design may either support or hinder patient care. Nonetheless, there is minimal evidence-based guidance in designing childbirth facilities. We validate a novel methodology of measuring and comparing quantitative design data among American childbirth facilities. METHODS: We requested annotated floor plans from 12 diverse childbirth facilities across the United States, ranging from birth centers to high-volume tertiary care centers. We redrew these floor plans to allow for comparison of key functional distances and areas. Specific measurements were selected using a modified-Delphi consensus process with experts in obstetrics, nursing, patient advocacy, evidence-based design, and hospital operations. RESULTS: Our cohort consisted of nine hospitals and three birth centers. Hospital delivery volumes ranged from 432 to 9,100 deliveries per year, and birth center delivery volumes ranged from 175 to 300 deliveries per year. The ratio of labor and delivery rooms to ORs ranged from 1.0 to 8.5 in hospitals. Annual deliveries per labor room ranged from 86.40 to 361.54 annual deliveries per room in hospitals and 87.50 to 100.00 annual deliveries per room in birth centers. CONCLUSION: We observed substantial variation in childbirth facility design and demonstrated the feasibility of collecting design data from diverse facilities. Given limited evidence-based design standards, future work is needed to understand the impact of variation in design on clinical processes in childbirth.