Becker's Hospital Review

83 FINANCE CMO / CARE DELIVERY 7 Ways Hospital Design May Affect C-Section Rates By Emily Rappleye T he physical design of a hospital's birthing unit may affect its Ce- sarean section rate, according to a new paper published by Ari- adne 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 hos- pital may impact C-section rates, the groups chose 12 diverse childbirth locations — three birth centers and nine hospitals. ey 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 chang- ing 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 poten- tial 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 deliv- ery 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. e 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 nurs- ing 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 oen 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 log- ically 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. e 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. e percent of unit space available for patients to "labor walk" or move around was associated with lower treatment intensity. While research- ers 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 be- tween facility design and important outcomes such as cesarean deliv- ery, 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. ey concluded the paper with a number of recommendations for hospitals to use when embarking on the design process for a new facility. n 3 RD ANNUAL HEALTH IT + REVENUE CYCLE CONFERENCE September 21-23, 2017 | Hyatt Regency | Chicago, Illinois 150 Speakers from Hospitals and Health Systems – 255 Speakers Total THE BRIGHTEST CIOS, HEALTH IT AND REVENUE CYCLE EXPERTS IN HEALTHCARE REGISTER HERE www.beckershospitalreview.com/health-it-revenue-cycle-conference/ Registration@BeckersHealthcare.com OR 800.417.2035. KEYNOTES BY George W. Bush, 43rd President of the United States of America Sugar Ray Leonard, Boxing Legend, Successful Entrepreneur and Author, The Big Fight: My Life In and Out of the Ring C-section rates can vary from 7 percent to 70 percent simply depending on the facility.

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