| Description |
Background:Cesarean sections have become a common operating room procedure in the United States, with approximately one-third of American women delivering by cesarean. Organizations such as the World Health Organization and U.S. Healthy People 2020 have identified the need to reduce Cesarean section rates significantly. Early labor admission is associated with increased medical intervention and morbidity, including birth by cesarean. Early Labor Lounges are a promising solution to the problem of early labor admission to the hospital and its subsequent interventions. Currently, the University of Utah Health does not have an Early Labor Lounge. Although a preliminary proposal was made to create one, hospital stakeholders required more information to consider the proposal. The purpose of this quality improvement project is to propose the creation of an Early Labor Lounge to stakeholders at the University of Utah Health, using information from the literature and information obtained from interviewing hospitals with existing Early Labor Lounges.Methods:Three hospitals with an Early Labor Lounge were identified in the United States, and a semi-structured interview was performed to gather information on the hospital implementation process, challenges, protocol, billing, and staffing. The collected data was presented to stakeholders in a scheduled meeting. Stakeholders were individuals that could make ELL implementation possible, including a Certified Nurse Midwife and the OB Medical Director who drafted the initial ELL proposal for the hospital. Other individuals included the Nurse Manager, Clinical Nurse Coordinator, and OBES lead 2 triage provider. Stakeholders were surveyed after the presentation to assess next steps to implement the recommendations at the University of Utah Health.Results:The hospital interviews revealed significant challenges in implementing Early Labor Lounge. The challenges included the patient's admission status, billing, unclear responsibilities of staff, staff resistance, risk management issues, and underutilization concerns. Due to the barriers to successful implementation experienced by existing Early Labor Lounges, the project recommendation to stakeholders was actually not to create an Early Labor Lounge, but instead, to implement various elements of existing Early Labor Lounges to support women in early labor. The post-presentation survey results indicate that the presentation was valuable in demonstrating the many challenges associated with implementing an Early Labor Lounge. However, three out of five stakeholders stated that the University of Utah Health could overcome the barriers faced by other hospitals by acquiring a more significant buy-in from hospital staff and launching a pilot study. Two out of five stakeholders did not want to pursue Early Labor Lounge, though they did wish to implement the alternative recommendations. However, all stakeholders stated that the intervention helped them view the challenges more clearly.Conclusions:This project was successful in gathering and then presenting to key stakeholders at University of Utah Health the available information on Early Labor Lounges, including information on billing, protocol, staffing, and the significant implementation challenges faced by existing Early Labor Lounges. The project also met its overarching goal toward the creation of an Early Labor Lounge, as the University of Utah Health will now pursue a pilot Early Labor Lounge. |
