The Impact of Labor and Delivery Unit Management on Long Childbirth Length of Stay [27L

Abstract

INTRODUCTION: The link between operational management of clinical services and quality of patient care has not been well characterized in obstetrics. We aimed to assess the impact of labor and delivery unit management practices on hospital length of stay (LOS) for low-risk patients during childbirth. METHODS: Using a validated instrument, we assessed the management practices of 51 diverse labor and delivery units across the United States. We constructed a patient-level relative risk regression model using all 226,463 low-risk patients discharged from these hospitals during 2013 and 2014. The model controlled for patient and hospital characteristics and accounted for clustering within hospitals. We defined our low-risk sample based on the AHRQ IQI#33 denominator specifications and excluded patients with ICD-9 codes indicating antepartum care. We defined long LOS as greater than 3 days for vaginal deliveries and greater than 5 days for cesarean deliveries. RESULTS: Delivering at a hospital with one standard deviation better patient flow management was associated with a 15% lower risk of long LOS (P=.004), and delivering at a hospital with one standard deviation better nursing management was associated with a 20% lower risk of long LOS (P < .001). In contrast, delivering at a hospital with one standard deviation better unit culture management was associated with a 30% higher risk of long LOS (P < .001). CONCLUSION: The management practices of labor and delivery units appear to independently influence the likelihood that a patient will experience prolonged hospitalization. Further research is needed to understand how optimal management can improve quality of care.