Project 4: Physical Design Elements of Patient Safety

Physical Design Elements of L&D Suite

There is increasing recognition that physical space and layout, including organization of equipment, can potentially impact the safety, efficiency, and quality of patient care.  In an analysis of preventable maternal mortalities, it has been estimated that facility factors contributed significantly to the fatal outcome in 75% of cases.

An optimally designed labor and delivery unit would support seamless workflow and optimize safety for mothers, babies, and staff. Our multidisciplinary team of clinicians and non-clinicians believes in the power of understanding users and utilizing design thinking to find novel ways to improve safety.

We are conducting observational studies and focus groups with providers and parents to explore what design features of current layouts are deficient and potentially hazardous.  Our research has discovered considerable design variation within and among labor and delivery units. 

We are using these findings to test and develop standards for building and remodeling the labor and delivery units of the future.

Estimating Obstetric Anesthesiology Workload 

In addition to site visits, we contacted two small scale projects using EMRs to evaluate how human factors elements like staffing-delivery ratios and physical design elements like room layout and may impact patient care and safety at Lucile Packard Children’s Hospital Stanford (LPCH).

The first project aims to estimate the workload of obstetric anesthesiologists. To factor in anesthesiology workload hours, delivery type was multiplied by an estimated total dedicated time associated with the anesthetic/analgesic procedure. After accounting for anesthetic or analgesic procedures per hour, we found that weekday shifts have 42% greater workload than weeknight and weekend shifts. If we factor in the time of anesthetic/analgesic procedures, then the workload on weekday shifts is 99% greater than weeknights and weekends shifts. The findings from this study highlights the importance of considering procedures and their relative duration in order to devise a better staffing plan for the labor and delivery unit. Sub-optimal planning of staffing levels can led to skewed workload ratios that could impose stress on the provider and harm patient safety.

An Analysis of Labor Room Usage and Cesarean Section Rates on High Volume, High Acuity Obstetric Unit: Does Layout Matter?

The second project studied how the layout of the labor and delivery rooms (LDRs) could influence cesarean section delivery (CD) rates. We found that charge nurses preferred to admit women at higher risk of CD to rooms of close proximity to OR. Rooms that are close in proximity to nursing station were preferably filled first.  Rooms with the furthest distance from monitoring station were preferred for low risk women. These room preferences based on perceived risk correlated with significant differences in CD rate. In summary, we found asymmetry in LDR use, CD rate, and rooming preferences. These results demonstrate 1) physical factors may be associated with resource utilization, and 2) charge nurses can stratify patient risk based on initial assessment. A rational future approach would incorporate these considerations and design a unit for stratification based on parturient risk.

Product Testing and Development

Non-Contact Vital Sign Monitor for the NICU

Conventional vital sign monitors use mechanical or adhesive sensors that physically contact the patient's skin. They are susceptible to artifacts and false alarms caused by patient movement and sensor dislodgment. Unfortunately, with infants in the NICU, the extremely fragile nature of the premature infant’s skin greatly increases these incidents.

Recent technology in visual analytics allows for detection of vital signs such as heart rate, respiratory rate, and temperature by using a camera without contact with the patient. Combining these data with environmental factors may reduce the rate of false alarms common in conventional vital sign monitoring systems in the NICU. Additional benefits include potentially improving the infant patient experience by reducing the number of physical connections, reducing the incidence of skin infection in premature infants caused by conventional sensor leads, and enhancing the level of patient care by correlating environmental and contextual information with changes in vital signs.

Our technology aims to deliver non-contact monitoring to determine vital signs including respiratory rate, heart rate, and temperature without attaching sensors to the infant’s skin. The study is being conducted at Lucile Packard Children’s Hospital Stanford to test, validate, and further the development of an innovative technology to improve vital sign monitoring in the NICU.

Pelvic Lift Cushion 

Hospital emergency departments and low resource clinics are in need of a simple low-cost solution to assist with pelvic exams. There are many ineffective work-arounds when an OB/GYN bed is not available. We are designing a simple, inexpensive product to help providers perform routine or emergency pelvic exams. We are currently manufacturing final prototypes for testing with real patients and doctors. We hope to begin the IRB approved pilot study winter 2017.

Delayed Cord Clamping Cart/NOOMA

Delaying umbilical cord clamping for 30-60 seconds after birth has been shown to have several benefits for babies; it may improve blood volume, reduce the incidence of intraventricular hemorrhage, and increase transfer of stem cells. In December 2012, the American College of Obstetricians and Gynecologists recommended delayed cord clamping for all preterm deliveries, and the American Academy of Pediatrics endorsed this statement in 2016.

Newborns requiring resuscitation may benefit from delayed umbilical cord clamping. However, providers frequently have to choose between delayed cord clamping and neonatal resuscitation because of space constraints, equipment insufficiencies, and concerns for sterility. We are developing and studying prototypes for simultaneously performing delayed cord clamping and neonatal resuscitation.