Relationship between Labor and Delivery Unit Management Practices and Maternal Outcomes

Avery C. Plough, Grace Galvin, Zhonghe Li, Stuart R. Lipsitz, Shehnaz Alidina, Natalie J. Henrich, Lisa R. Hirschhorn, William R. Berry, Atul A. Gawande, Doris Peter, Rory McDonald, Donna L. Caldwell, Janet H. Muri, Debra Bingham, Aaron Caughey, Eugene R. Declercq, Neel T. Shah

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

OBJECTIVE: To define, measure, and characterize key competencies of managing labor and delivery units in the United States and assess the associations between unit management and maternal outcomes. METHODS: We developed and administered a management measurement instrument using structured telephone interviews with both the primary nurse and physician managers at 53 diverse hospitals across the United States. A trained interviewer scored the managers' interview responses based on management practices that ranged from most reactive (lowest scores) to most proactive (highest scores). We established instrument validity by conducting site visits among a subsample of 11 hospitals and established reliability using interrater comparison. Using a factor analysis, we identified three themes of management competencies: Management of unit culture, patient flow, and nursing. We constructed patient-level regressions to assess the independent association between these management themes and maternal outcomes. RESULTS: Proactive management of unit culture and nursing was associated with a significantly higher risk of primary cesarean delivery in low-risk patients (relative risk [RR] 1.30, 95% CI 1.02-1.66 and RR 1.47, 95% CI 1.13-1.92, respectively). Proactive management of unit culture was also associated with a significantly higher risk of prolonged length of stay (RR 4.13, 95% CI 1.98-8.64), postpartum hemorrhage (RR 2.57, 95% CI 1.58-4.18), and blood transfusion (RR 1.87, 95% CI 1.12-3.13). Proactive management of patient flow and nursing was associated with a significantly lower risk of prolonged length of stay (RR 0.23, 95% CI 0.12-0.46 and RR 0.27, 95% CI 0.11-0.62, respectively). CONCLUSION: Labor and delivery unit management varies dramatically across and within hospitals in the United States. Some proactive management practices may be associated with increased risk of primary cesarean delivery and maternal morbidity. Other proactive management practices may be associated with decreased risk of prolonged length of stay, indicating a potential opportunity to safely improve labor and delivery unit efficiency.

Original languageEnglish (US)
Pages (from-to)358-365
Number of pages8
JournalObstetrics and Gynecology
Volume130
Issue number2
DOIs
StatePublished - Aug 1 2017
Externally publishedYes

Fingerprint

Practice Management
Mothers
Length of Stay
Nursing
Interviews
Postpartum Hemorrhage
Blood Transfusion
Statistical Factor Analysis
Nurses

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Plough, A. C., Galvin, G., Li, Z., Lipsitz, S. R., Alidina, S., Henrich, N. J., ... Shah, N. T. (2017). Relationship between Labor and Delivery Unit Management Practices and Maternal Outcomes. Obstetrics and Gynecology, 130(2), 358-365. https://doi.org/10.1097/AOG.0000000000002128

Relationship between Labor and Delivery Unit Management Practices and Maternal Outcomes. / Plough, Avery C.; Galvin, Grace; Li, Zhonghe; Lipsitz, Stuart R.; Alidina, Shehnaz; Henrich, Natalie J.; Hirschhorn, Lisa R.; Berry, William R.; Gawande, Atul A.; Peter, Doris; McDonald, Rory; Caldwell, Donna L.; Muri, Janet H.; Bingham, Debra; Caughey, Aaron; Declercq, Eugene R.; Shah, Neel T.

In: Obstetrics and Gynecology, Vol. 130, No. 2, 01.08.2017, p. 358-365.

Research output: Contribution to journalArticle

Plough, AC, Galvin, G, Li, Z, Lipsitz, SR, Alidina, S, Henrich, NJ, Hirschhorn, LR, Berry, WR, Gawande, AA, Peter, D, McDonald, R, Caldwell, DL, Muri, JH, Bingham, D, Caughey, A, Declercq, ER & Shah, NT 2017, 'Relationship between Labor and Delivery Unit Management Practices and Maternal Outcomes', Obstetrics and Gynecology, vol. 130, no. 2, pp. 358-365. https://doi.org/10.1097/AOG.0000000000002128
Plough, Avery C. ; Galvin, Grace ; Li, Zhonghe ; Lipsitz, Stuart R. ; Alidina, Shehnaz ; Henrich, Natalie J. ; Hirschhorn, Lisa R. ; Berry, William R. ; Gawande, Atul A. ; Peter, Doris ; McDonald, Rory ; Caldwell, Donna L. ; Muri, Janet H. ; Bingham, Debra ; Caughey, Aaron ; Declercq, Eugene R. ; Shah, Neel T. / Relationship between Labor and Delivery Unit Management Practices and Maternal Outcomes. In: Obstetrics and Gynecology. 2017 ; Vol. 130, No. 2. pp. 358-365.
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AU - Galvin, Grace

AU - Li, Zhonghe

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AU - Alidina, Shehnaz

AU - Henrich, Natalie J.

AU - Hirschhorn, Lisa R.

AU - Berry, William R.

AU - Gawande, Atul A.

AU - Peter, Doris

AU - McDonald, Rory

AU - Caldwell, Donna L.

AU - Muri, Janet H.

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