The physical design of a hospital's birthing unit may affect its Cesarean section rate, according to a new paper published by Ariadne Labs and MASS Design Group.
Based on previous research conducted by Ariadne Labs, the groups knew C-section rates can vary from 7 percent to 70 percent simply depending on the facility. As many as half of these C-sections are unnecessary and add surgical complications and additional spending into the healthcare system. To begin to determine how much the physical layout of a hospital may impact C-section rates, the groups chose 12 diverse childbirth locations — three birth centers and nine hospitals. They conducted site visits and phone interviews to develop facility profiles and compare the childbirth locations as quantitatively as possible.
"[O]ur observations collectively clarify many of the ways that design can either help or hinder clinicians in caring for patients, particularly with regard to enabling flexibility/ adaptability in responding to changing patient needs, facilitating knowledge sharing and distribution of workload, and creating physical or cognitive 'anchors' that reinforce certain patterns of work," the authors wrote.
While their findings are intended to be a starting point, used for wider testing and deeper exploration, they highlight some interesting potential connections between design and efficiency.
Here are seven key findings highlighted in the report.
1. Higher room demand — or the annual delivery volume per labor delivery room — is associated with higher C-section rates and may contribute to overuse of the surgical procedure.
2. Facility size — or the deliveries per square foot of the unit — may be positively associated with higher C-section rates. While this may be counterintuitive when compared with the first finding, the researchers noted there is a point of diminishing returns when it comes to facility size; there is a point when a facility is too big. At this point, travel times between rooms can be detrimental to patient care or there is a loss of intimacy reported by patients.
3. The distance between patient rooms as well as the distance from workstations to patient rooms can drive up treatment intensity and is associated with increased rates of C-sections. Large rooms can also contribute to this problem, effectively adding to the distance between rooms, as well as layout — rooms in a cluster are closer than rooms on opposite ends of a long hallway.
4. Similarly, the distance between call rooms, which providers and nursing staff can use for administrative work or rest, and patient rooms is linked to greater C-section rates. However, the researchers noted across many of the facilities, staff often must give up these spaces to increase space for patient care, such as for patient and family waiting rooms.
5. Room standardization does not affect C-section rates. Despite logically increasing efficiency, the study suggests little to no benefit from creating the same environment from room to room.
6. Fewer collaborative spaces for staff may be associated with greater C-section rates. The researchers suggest more collaborative space allows for greater levels of motivation and accountability. However, they note an element of motivation and accountability comes from team culture — it could also lead to more patient monitoring and more C-sections.
7. The percent of unit space available for patients to "labor walk" or move around was associated with lower treatment intensity. While researchers were unable to measure how other contextual and cultural factors impacted C-section rates, they noted a large range between facilities in the accessibility of labor and support equipment like birthing balls, tubs or squat bars; the prominence of technology; as well as the availability of natural light.
"Our observations also suggest the possibility of an association between facility design and important outcomes such as cesarean delivery, and provide the basis for a number of specific testable hypotheses for how quantitative and qualitative design metrics may be linked with processes of care," the authors wrote. They concluded the paper with a number of recommendations for hospitals to use when embarking on the design process for a new facility.
Read the full paper here.
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