gms | German Medical Science

Background: In Germany, there are no binding guidelines for staffing levels in obstetrics. A recommended staffing ratio of 1:1 is suggested. Providing high-quality maternity care is an investment in the sustainable health of women and children and helps to preserve the long-term health of midwives and midwifery students. In practice, this staffing ratio is often exceeded. Overburdened delivery rooms are regularly logged off due to overcrowding, resulting in rejections during acute situations and additional workload in already very busy situations. In 2019, the “Points System for Operationalizing Workload in a Delivery Room” (POAK) was developed to provide birth-specific and risk-specific care to women. To ensure the safety of the birthing women, a 1:2 care ratio (one midwife for two low-risk birthing women) should not be exceeded. The goal of this work is to assess and systematically evaluate the workload of a delivery room over a three-month period based on the POAK instrument.

Research questions: 1. How is the workload in the delivery room characterized over a three-month period based on the POAK instrument? 2. What recommendations for adapting documents to monitor workload in a delivery room can be derived from the conducted assessment?

Methodology: Data collection is based on the POAK system. The workload is recorded at two time points on an analog document during each shift. Various parameters of rejected women are noted on another document. The data will be collected prospectively for three months from August 10 to November 10, 2023 (an extension until February 28, 2024, has been granted). Subsequently, the data will be analyzed using descriptive statistical methods, and recommendations for adapting the monitoring documents will be developed.

Results: In this initial assessment, an anticipated 279 datasets with generally high workload and recurring logoffs of the delivery room are expected. Recommendations for adapting the points system may involve changes to the documents or scheduling measures.

Significance: Given the high workload in German delivery rooms and strained personnel resources, the study contributes to filling an information gap regarding objectively measurable workload in delivery rooms. By depicting workload variance, identifying reasons for logoffs, and describing the collective of rejected women, the study aids in improving data quality in operational and strategic hospital management.

Conclusions: The three-month pilot study on measuring delivery room workload can provide a valuable data set for health services research and hospital planning. For comprehensive monitoring, delivery room workload should be continuously recorded, ideally digitalized, uniformly and comprehensively across the country. This will enable the sustainable allocation of limited resources in line with the safety and satisfaction of birthing women and families and allow for the derivation of personnel measures to reduce high workloads.

Ethics and conflicts of interest: This abstract was written in the context of a bachelor’s thesis. The internal ethics committee approved the pilot study on August 9, 2023. The research was financed by own resources. There are no conflicts of interest.