The Effect of Surges in Patient Volume on Resource Management of an Academic Labor and Delivery Unit [5D

Abstract

INTRODUCTION: Clinical managers in charge of labor and delivery units are challenged by the need to allocate scarce resources, such as beds and nursing staff, when there are surges in patient volume. When particularly busy, managers may resort to a variety of strategies, such as calling in additional staff or delaying new admissions. The thresholds for applying strategies that preserve labor floor resources have not been previously well defined and may have significant implications for patient safety. METHODS: We developed a virtual labor floor environment in JAVA to simulate dynamic labor floor conditions, including the expected waxing and waning of patient acuity and volume over the course of a nursing shift. We recorded an inter-professional cohort of clinicians making resource allocation decisions over multiple simulated shifts. Using logistic regression, we determined the odds of delaying admission for patients in early labor when labor floor occupancy varied. RESULTS: Eight nurses played the game for 20 minutes on average, which translates to 64 simulated hours of decision-making. In a logistic regression model, we found there is an increased odds of delaying admissions for early labor as the percent of labor and delivery bed occupancy increases (unadjusted odds ratio 1.11, 95% confidence interval 1.03, 1.19). CONCLUSION: Early labor admissions were more often delayed with increasing bed occupancy, indicating that the care of patients on labor and delivery units may be sensitive to the total occupancy of the unit. Additional research is needed to understand the impact of resource management on patient safety.