LDRP

A few months ago, we moved into our brand new labor and delivery unit, something we've been looking forward to since 2007 with excitement and trepidation.  The layout of the huge new unit, how we provide care changed a little bit when we moved from a LDR model to a LDRP model.  No more moving from the labor room to the post-partum floor.  Everything happens in one room, with one hallway dedicated to antepartum/postpartum for our preterm labors/antepartums and scheduled c-sections.  We are more baby friendly than we were in the past - almost every baby stays with mom unless she requests the baby to go to the nursery, all care is given at the bedside if possible, skin-to-skin is initiated, unless declined or mom/baby is unable to, within 30 minutes of birth.  And, something I'm VERY excited about:  skin to skin in the OR!!!  That has been a slower process of change with that, but it's been wonderful to see and I think its a huge benefit to moms and babies.  Even with all the positive changes, there have been some kinks, as you would expect when you move from one unit to a brand new unit and changing the model of care.  It's hard to staff an LDRP.  We have a triage area now.  The idea was the triage nurse would admit, decide if they are labor or not and if they are admitted, hand off to a L&D RN.  But in a unit that is relatively small compared to big city hospitals, it's a bit tricky because we just don't have the staff and don't do enough business to make that work and keep the cost down.  So frequently, that triage nurse will admit the patient, the patient turns into labor and then that triage nurse has to move the patient to a LDRP room, admit her and that just adds more time onto the admission.  Another hiccup is the layout of the unit.  It's huge and we are all so spread out.  And there isn't a central nurses station so knowing what is going on with other patients, what docs have patients there, etc., has proven to be a challenge.  We are getting better but I know there have been times we've called a doc for something who had just been called about another patient, or a doc calls wanting to talk with their patient's nurse and we didn't know who the nurse was.  Thankfully, over the last months, that issue is getting better.  It's a process, and we've had to be flexible and adapt.  Overall, its been great. Patients are happier, patient care is better and even though there has been a little bit of disorganization in the beginning, it never affected the patients and it wasn't any worse than what was to be expected. When comparing our old unit to the new unit, it's like comparing a Super 8 motel and the Hilton.  Both work for what they are designed for, but it's much nicer to stay at the Hilton.