Labor and delivery nurse staffing as a cost-effective safety intervention.
Numerous studies have identified a relationship between staffing levels and nurse-sensitive outcomes for medical and surgical patients, but little has been published on the impact of nurse-sensitive outcomes for the childbearing family and even less that examines the relationship of intrapartum staffing on adverse perinatal outcomes. Using a derivation of Donabedian's classic structure, process, and outcomes framework, a model is proposed, which would allow obstetrical primary care providers and administrators alike the opportunity to examine the influence of nurse staffing on adverse obstetrical events, including unanticipated cesarean birth in low-risk women or newborn intensive care unit admissions. It is recognized that hospitals carry a significant burden in the prevention of adverse outcomes that range from nurse staffing levels to the internal process and infrastructure of the hospital setting. Patient outcomes are a direct result not only of the patient's health status and characteristics (eg, socioeconomic position and ethnicity), but also of interactions with the healthcare delivery system. As such, the opportunity to examine hospital characteristics (structure and processes) that may be detrimental to safe patient outcomes is of paramount importance in providing optimal outcomes for childbearing women and their families.
Center for Improving Health Outcomes in Children, Teens, and Families, Arizona State University College of Nursing and Health Innovation, Phoenix, Arizona, USA. Barbara.l.wilson@asu.edu
Barbara L
BL
Wilson
Mary
M
Blegen
D005260:Female; D019983:Guideline Adherence / Q000458:organization & administration; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal / Q000458:organization & administration; D009741:Nursing Staff, Hospital / Q000191:economics / Q000592:standards*; D009773:Obstetric Nursing / Q000191:economics / Q000592:standards; D009775:Obstetrics and Gynecology Department, Hospital / Q000458:organization & administration*; D010043:Outcome and Process Assessment, Health Care / Q000191:economics / Q000592:standards; D010561:Personnel Staffing and Scheduling / Q000458:organization & administration; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology / Q000517:prevention & control*; D011256:Pregnancy Outcome / Q000191:economics / Q000453:epidemiology