Implications of a Decentralized Postpartum Unit Design and Clinical Operations

Abstract

Objectives: This postoccupancy study sought to understand whether a decentralized unit design supported a postpartum care delivery model by evaluating nurses’ efficiency, staff perception, acoustical conditions, and patient satisfaction. Background: Today, standardization and decentralization design concepts are being applied to all types of inpatient unit. There have been many studies that investigated how these concepts influence care delivery on medical-surgical units, but no study has evaluated a postpartum unit. Methods: This study utilized a mixed-method approach that involved unobtrusive shadowing (roughly 25 hr) and surveying ( n = 19) of nursing staff, physical acoustic readings (eight, 24-hr readings), and comparison of patient satisfaction pre- and postmove. Results: On average, nurses spent roughly 36.90% of their time at charting stations. Nurses were observed mostly using the central charting station located at the entry of the unit and adjacent to the well-baby nursery rather than the five decentralized chart stations. This was due to nurses operating with old workflow habits, not fully integrating electronic medical records, and needing to be near the nursery and other nurses. Nurses were satisfied with their ability to interact and their proximity to supplies, patients, and team members while in the central charting station. Additionally, patient satisfaction significantly increased postmove, particularly with the overall hospital’s quietness and cleanliness. Conclusion: This study highlights the importance of aligning administrative operations of the unit with the design intent. Although standardization and decentralization design concepts aimed to improve nurses’ workflow, misalignment with the operations may not deliver the most optimal outcomes.