Is there a facility that offers both LDR & LDRPs ; What are the Pros and Cons of LDRP

mjb324 · Sep 27, 2008

Our unit went to ldrp format in 2000. At that time we were only doing about 80 deliveries per month. We have 14 ldrp's. We are now doing close to 200 deliveries per month and about 400 outpatients per month and we rapidly outgrew our dept. Two years ago we opened a mother/baby unit seperate from our floor. Now we have both ldrp and ldr's. Our goal is to become completely ldr only.:) The ldrp's are nice in the fact the patients don't have to pack up all their belongs and move them. Otherwise, the birthing beds are uncomfortable. We purchased mattress to cover them, but they disappeared within months. The noise level can somethimes be an issue. Like the out of control mom who is screaming her lungs out and refuses pain meds. Plus, if the unit gets busy with other labor patients there would be a bed situation. :banghead: We would scramble to see who we could discharge early so we could get an opened ldr. Plus, when we were busy, our first priority was to our laboring pts.

Since, we have opened our m/b unit. The majority of our pts request to go their instead of staying in the ldrp. The beds are comfortable. Dad gets his own bed and they have plasma tv's. The pts also understand the level of their care has changed. While pts are laboring they see their nurse every 15-30minutes and have alot of one on one. Then they deliver and that time frame changes and patients felt like their nurse left them. Sending them to m/b, they understand the level of care changed and are happier. We always try to perform hourly rounding on all delivered pts. It is just easier in an ldr and m/b unit.

Jolie, BSN · Sep 27, 2008

Back in the late '80's, I worked in a hospital that was planning a transition from separate L&D, PP and Nsy to LDRP and NICU.

The architect cited a study that demonstrated a much higher cost of developing, equipping, maintaining and staffing a large LDRP unit (about 20+ beds) versus LDRs with a separate M-B unit. On a small scale, apparently there wasn't much difference, but for large units with high volume of deliveries, there was.

It makes sense. Building and equipping labor rooms is expensive. They need to be large enough for a delivery bed, table, infant warmer, resuscitation cart, several staff members (at the time of delivery) and the patient's family. Once mom and baby are safely recovered, keeping them in a room with all that unnecessary space and equipment just isn't cost effective. Some hospitals answer that by removing equipment from the birth room after delivery and transferring it to another room to set up for a new labor admission, but that can create confusion as to which rooms are "labor ready". It also spoils the "feel" of the single-room maternity philosophy when a tech runs in to take and clean equipment while a family is bonding, because it is needed next-door, or has to run in just prior to delivery with a clean infant warmer and cart.

Our hospital opted for LDR with MB, and it worked well. The staff preferred it also, because cross-training was not required.

jenrninmi, MSN, RN · Sep 27, 2008

My hospital switched from LDRP to LDR exactly 1 year ago. (Built a new hospital). It was quite a transition having to transfer our patients to MB (usually we keep our patient when she goes to MB unless their is another labor patient. We only deliver about 60 to 70 a month). I still miss our LDRPs.

cassioo, RN · Sep 29, 2008

I worked per diem at a hospital that was LDRP. It was a new place and soon had to expand. They equip every room with a labor bed so that's what you get the whole time. Warmers and delivery tables are kept in a clean area and taken to rooms as needed and removed when finished with them so not every room has it all at all times. There are 2 nurseries and a NICU. If a pt is scheduled for c/s or goes for emergency they usually end up on a GYN hall with regular bed (just 1 hall on the backside of the labor hall that connects). There are 3 nurses stations so depending on where the patients are located you may have a couple of L&D nurses and a couple of PP nurses all at the same desk. Noise really didn't seem to be a problem there if you shut the door. Most of the doctors had offices upstairs so just had to run down the steps when called so it worked out pretty nicely. The other hospital across town tried LDRP and it didn't really work out for them so they went back to seperate. Where I'm at full time we're seperate and it really wouldn't work out for us because of our patient population and PP also takes care of GYN. It's a smaller community hospital.

janelrn · Oct 1, 2008

I work in a hospital that has 2 sections of L&D (sortof). Side A is a 7 room LDRP only section. The rooms are arranged so that there is a small supply room between 2 rooms (think 2 bedrooms sharing a closet with a supply pyxis). Side B has 4 LDRs, plus 12 high-risk antepartum/labor rooms, 4 delivery/OR suites, and a 2 bed C-section/BTL PACU. Within the Women's division there is also a NBN/convalescent nursery and an antepartum/postpartum/GYN floor. We average 300-350 deliveries a month.

Patients that meet LDRP admission criteria are given the choice (as available) of which type of rooming arrangement they would prefer.

I work primarily on Side A and love it :heartbeat. I personally love caring for my patients from the time they come in to the time they go home. I love that the relationship that was developed through labor and strengthened with delivery is not "back to square one" with having my patient need to now form a relationship with a new nurse while also exploring the new dynamics of her family :nurse: . Yes, noise can be a factor, but surprisingly rarely is. A baby who is crying all night because they have finished the "sleepy phase" is more disruptive. The factor that is more of a problem is when you have a mom that has labored all night, delivered during the day, then the first postpartum night is so exhausted that caring for the baby is pushing her past her limit :bluecry1: . Having the nursing and family support is so important to make the mother/baby concept work. When our staffing is within target (4 nurses on side A), a typical assignment is a mix of m/b couplet and a labor. Ideal is to have the Charge nurse with a stable couplet, then each nurse has a higher acuity and a lower acuity patient. The CN can then step in to assist when care for one of your two patients makes it that you cannot be there for your other patient's needs. Of course, we all know that this is not always possible :banghead: . It is the goal. But even when you cannot be in with your couplet as much as you need with 2 patients (or 3 couplets), is that any different than a m/b unit where 1:3-4 couplets is the norm?

Hope this helps :typing!

Janel

SmilingBluEyes · Oct 1, 2008

I am on my way out the door to work. But I can help you later....

I have worked both LDR and LDRP and can draw comparisons for you from personal experience. I will be back later with more.

Meantime, I see some folks have come in to help. I am glad for that.

crystal013 · Oct 2, 2008

Hi JANELRN!

Your unit sounds like where I work at PCMH in Greenville, NC...

hehe...

Crystal

jhhrn68 · Oct 3, 2008

Where I work has a separate L&D, postpartum and nursery. And I have worked in a hospital with a small LDRP unit - just 8 rooms in a circle around a central nurses station. I think LDRP's work best in a small unit with not a lot of deliveries. I interviewed for a job at a hospital with a very large unit of LDRP's and I said "no thanks" - too much running up and down those long halls.

SmilingBluEyes · Oct 4, 2008

I agree with those saying LDRP works well in smaller units. I like these for our patients; they don't have to move rooms and they love it, too. In large hopitals with much volume, LDR, and PP do work better, really. The flow is better, less running around for nursing staff and you need those rooms for new admits in labor. The other advantage, is some patients really do appreciate having a "new clean room" for their post partum stay. It's almost like a "fresh start" for them. The LDRP can appear very dirty if not cleaned properly after birth-----and that can be a major turnoff for families. Otherwise, the others have said it well before me.