A study of New York City obstetrics units demonstrates the potential for reducing hospital inpatient capacity

Obstetric Outcomes of Nighttime Versus Daytime Delivery with Labor Epidural: An Observational Retrospective Study

Background: Variability in obstetric outcomes in terms of the number and type of deliveries related to the day-night cycle has been described in previous studies. This 11-year retrospective analysis explores the effects of nighttime versus daytime delivery with labor epidural on obstetric outcomes. Methods: Data on deliveries performed between 1 October 2008 and 1 October 2019 were collected and differentiated into daytime, occurring from 8:00 a.m. to 7:59 p.m., and nighttime deliveries, occurring from 8:00 p.m. to 7:59 a.m. of the following day. The data collected included the patient history and maternal and neonatal outcomes. Results: A total of 29831 patients were included in the analysis. A positive and statistically significant correlation between the number of cesarean sections (Odds Ratio 1.35; 95% confidence interval = 1.26-1.44; p < 0.001) and the number of vaginal operative deliveries (Odds Ratio 1.21; 95% confidence interval = 1.01-1.44; p < 0.05) in patients who did not receive an epidural at nighttime was reported. Regarding the labor epidurals, a significantly greater incidence of accidental dural punctures with needles (0,4%; p < 0.05) in the nighttime versus daytime was reported. Conclusions: The absence of labor epidurals was associated with a significant increase in the number of cesarean sections and vaginal operative deliveries occurring at nighttime, without significant differences in labor duration. The incidence of anesthesiologic complications was greater in deliveries performed at nighttime.

An approach by human and material resources combination to reduce hospitals crowding

Purpose

This paper aims to propose an approach by human and material resources combination to reduce hospitals crowding. Hospitals crowding is becoming a serious problem. Many research works present several methods and approaches to deal with this problem. However, to the best of the authors’ knowledge – after a deep reading of literature – in all the proposed approaches, human and material resources are studied separately while they must be combined (to a given number of material resources an optimal number of human resources must be assigned and vice versa) to reflect reality and provide better results.

Design/methodology/approach

Hospital inpatient unit is chosen as framework. This unit crowding reduction is carried out by its capacity increasing. Indeed, inpatient unit modeling is performed to find the adequate combinations of human and material resources numbers insuring this unit stability and providing optimal service rates. At first, inpatient unit is modeled using queuing networks and considering only two resources (beds and nurses). Then, the obtained service rate formula is improved by including other resources and parameters using Baskett, Chandy, Muntz and Palecios (BCMP) queuing networks. This work is applied to “Princess Lalla Meryem” hospital inpatient unit.

Findings

Results are patients’ average number reduction by an average (in each block) of three patients, patients’ average waiting time reduction by an average of 9.98 h and non-admitted patients (to inpatient wards) access percentage of 39.26 per cent on average.

Originality/value

Previous works focus their studies on either human resources or material resources. Only a few works study both resources types, but separately. The context of those studies does not meet the real hospital context (where human resources are combined with material resources). Therefore, the provided results are not very reliable. In this paper, an approach by human and material resources combination is proposed to increase inpatient unit care capacity. Indeed, this approach consists of developing inpatient unit service rate formula in terms of human and material resources numbers.