Impact of electronic cardiac (ECG) monitoring on delivery room resuscitation and neonatal outcomes.

AIM: In 2016, the neonatal resuscitation guidelines suggested electronic cardiac (ECG) monitoring to assess heart rate for an infant receiving positive pressure ventilation immediately after birth. Our aim was to study the impact of ECG monitoring on delivery room resuscitation interventions and neonatal outcomes. METHODS: Observational cohort study compared maternal, perinatal and infant characteristics, before (retrospective cohort, calendar year 2015) and after (prospective cohort, calendar year 2017) implementation of ECG monitoring in the delivery room. Association of ECG monitoring with delivery room resuscitation practice interventions and neonatal outcomes was assessed using unadjusted and adjusted multivariable regression analyses. RESULTS: Of 632 newly born infants who received positive pressure ventilation in the delivery room, ECG monitoring was performed in 369 (the prospective cohort) compared with no ECG monitoring in 263 (the retrospective cohort). Compared to neonates in the retrospective cohort, neonates with ECG monitoring had a significantly lower endotracheal intubation rate (36% vs 48%, P < .005) in the delivery room and higher 5-min Apgar scores (7 [5-8] vs 6 [5-8], P < .05). There was no difference in mortality (31 [8%] vs 23 [9%]), but infants who received ECG monitoring had increased odds of receiving chest compressions with an adjusted odds ratio of 3.6 (95% confidence interval: 1.4-9.5). CONCLUSION: Introduction of ECG monitoring in the delivery room was associated with fewer endotracheal intubations, and an increase use of chest compressions with no difference in mortality.

Common challenges managing bed and staff availability on labor and delivery units in the United States: A qualitative analysis.

BACKGROUND: Managers of labor and delivery units need to ensure that their limited supply of beds and nursing staff are adequately available, despite uncertainty with respect to patient needs. The ability to address this challenge has been associated with patient outcomes; however, best practices have not been defined. METHODS: We conducted a secondary analysis of 96 interviews with nurse and physician managers from 48 labor and delivery units across the United States. Included units represented a diverse range of characteristics, but skewed toward higher volume teaching hospitals. The prior study scored management practice based on their proactiveness (ability to mitigate challenges before they occur). Based on emerging themes, we identified common challenges in managing bed and staff availability and performed an analysis of positive deviants to identify an additional criterion for effective management performance. RESULTS: We identified four key challenges common to all labor and delivery units, (1) scheduling planned cases, (2) tracking patient flow, (3) monitoring bed and staff availability in the moment, and (4) adjusting bed and staff availability in the moment. We also identified "systematicness" (ability to address challenges in a consistent and reliable manner) as an emerging criterion for effective management. We observed that being proactive and systematic represented distinct characteristics, and units with both proactive and systematic practices appeared best positioned to effectively manage limited beds and staffing. DISCUSSION: Labor and delivery unit managers should distinctly assess both the proactiveness and systematicness of their existing management practices and consider how their practices could be modified to improve care.

Predicting nurse staffing needs for a labor and birth unit in a large-volume perinatal service.

This project was designed to test a nurse staffing model for its ability to accurately determine staffing needs for a large-volume labor and birth unit based on a staffing gap analysis using the nurse staffing guidelines from the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN). The staffing model and the AWHONN staffing guidelines were found to be reliable methods to predict staffing needs for a large-volume labor and birth unit.

El renacer de una sala de partos / A labour room is re-born

El Servicio de Urgencias Gineco-Obstétricas, conocido por “Sala de Partos” es un servicio con una actividad asistencial muy marcada por los pacientes obstétricas. También, existe un grupo notable de pacientes ginecológicas, a pesar de que esta última actividad representa un porcentaje mucho menor. El servicio tiene una voluntad universitaria muy acusada, aunque la investigadora se encuentra obstaculizada por la organización actual y por el gran volumen asistencial. La “Sala de Partos” (SP), está muy orientada a la demanda de la puerta de urgencias y a todas las intervenciones que de éstas derivan. La Dirección del Servicio de Obstetricia, se plantea la creación de una SP con mayor autonomía de gestión, orientada a un modelo organizativo basado en el proceso asistencia. En este caso se va analizar la estructura y la actividad e la SP actual y posteriormente se discutirán oportunidades de mejora en la gestión clínica y la eventualidad de la fusión o no con las urgencias ginecológicas (AU)

The obstetrics and gynecology emergency service, Known as the “Labour Ward”, is a service whose nursing care is highly marked by obstetrics patients. The “Labour Ward” is oriented to emergency demands and all the interventions deriving from this. This work analyses the structure and activity of the current Labour Ward and discusses opportunities for improving clinical management and the possibility of its fusion with gynecological emergencies (AU)