The acronym LDRP stands for labor, delivery, recovery and postpartum. According to the 2009 Medical Dictinary, the acronym “describes a maternity unit for family-centered care. Women in labor and their families complete normal childbearing experiences in one home-like room. The newborn may remain at the bedside throughout the stay.”
LDRP suite design has changed within recent hospital planning to incorporate and consider the patient experience. Previous to the shift to labor, delivery and recovery rooms (LDR) or an LDRP suite, patients were moved to a different room within a hospital for each step of the birthing process. The time to transition patients to the different spaces was not advantageous.
The decision to incorporate an LDR versus an LDRP suite design should be carefully examined, evaluated and decided by the design team and the hospital planning committee. This choice will impact the adjacencies of support and other ancillary spaces. It may require the shift of certain departments to be closer to minimize the potential patient travel time.
In the book “Hospital Interior Architecture,” the author Jain Malkin says within an LDRP suite, there must be room to accommodate examination and preparation, labor, delivery, rest and sleep, family visiting, waiting and infant care. According to Malkin, to provide accommodations for the aforementioned space activities, consider the following design elements:
Typically, LDRP suites include a patient care area with a patient bed and headwall, a baby bath sink, infant assessment and care area, and a restroom and shower.
Codes, Design Guidelines
Most facilities have a set of facility standards to follow or keep in mind when designing a space within their campus. It is the designer’s responsibility to work closely with the facility authority to understand its standards and offer guidance if needed to help clarify design direction or decisions. In addition to the local codes such as city ordinances and state building codes to follow with design, there also are guidelines to follow such as Facility Guidelines Institute (FGI) Guidelines.
At a minimum per the FGI Guidelines, the following must be included in an LDR or LDRP suite:
Table 1 outlines medical gas and vacuum system requirements. Outlets shall be located in the room so they are accessible to the mother’s delivery area and infant resuscitation area.
The priority of the design team should be the experience and health of the patient. Great care and consideration should be taken to ensure the room works seamlessly with the medical staff performing the various medical activities associated with these spaces. The engineered systems and support systems — the plumbing, gases, lighting and power — should be consciously considered to anticipate the needs of the patient and aid the staff in performing the best possible patient care.
Renovation of an LDRP
For this study, let’s consider a renovation of an existing LDRP with eight beds and one central nurse’s station into six rooms with a refurbished central nurse station. The LDRP suite is 14,057 sq. ft. Supporting spaces are not included in the phase of this project but have been recently renovated and are up to the latest requirements.
Each LDRP room will have a private restroom with shower, water closet and lavatory. Each will have a baby bath that can be operated by either wrist-blade handles or foot pedals, with the option to divert the water flow to a hand-held shower. Each room will have the flexibility to accommodate a mobile whirlpool birthing tub with hot- and cold-water connections and a drain. Medical gas outlets are available within the headwall of the room and the bassinette area.
There are a few additional obstacles with this project to consider.
Two aspects of this project were particularly challenging — the stacked chases and the construction phasing of the project.
Stacked chases. The location of the stacked chases was within the common wall of the private restrooms previously serving each LDRP room. Above and below this floor is a similar floor plan with the restrooms stacking one on top of another. The chases accommodate the previous design of the vertically circulated plumbing piping. Since the new design no longer required stacked restrooms, it had to accommodate for the reserving and relocating of the plumbing piping as necessary.
Incorporating plumbing offsets as required and additional shut-off valves in accessible locations will allow the users to control the system better. After the renovations are completed, the vertical risers that are no longer serving a space are to be shut off by the shutoff valves and drained. Excess piping will be removed and permanently capped.
Phasing. This project was to be constructed in phases to limit the amount of downtime for the LDRP suite, as well as ensure enough LDRP rooms were available to be used to meet the demand of the patients. Working with the design team and the facility manager, the construction phasing was determined.
For the plumbing design, the previously vertically circulated chases were reworked to feed the floor from a few locations, then horizontally circulated. The few locations were to accommodate the construction phasing. Each reworked vertical location was extended, valved and capped for the extension and future renovation of the floor above.
The centralized medical gas risers fed the medical gas system. The construction phases were accommodated with strategically placed shut-off valves to limit the amount of recertification required for the medical gas system.
The project design integrated three innovative solutions: the baby bath design, the accommodations for the mobile whirlpool birthing tub and the medical gas casework integration.
Baby bath design. The baby bath incorporates wrist-blade controls with foot pedal controls and the option to divert the flow from a laminar flow faucet to a hand shower to cleanse the baby. No packaged technology exists that brings together all those functions in one seamless design. By incorporating a third water connection and a hand shower with a diverter, the functionality needed by the medical staff was attained.
Mobile whirlpool birthing tub. Whirlpool birthing tubs are becoming a more popular method to ease pain associated with the birthing process. Since not all facilities can offer dedicated LDRP suites for water births, the mobile whirlpool birthing tub is becoming more prevalent in design. The particular whirlpool tub used for this project required a hot and cold hose bibb connection, as well as a large drain within the cabinet and on the floor of the room at the approximate location of the mobile tub.
Working with the architect, a cabinet was included for the hoses required for filling and emptying the mobile tub. It contained a water supply box with domestic hot water, domestic cold water and drain connections. The location was reviewed by the design team with the facility managers and LDRP suite staff to ensure the use and maintenance was taken into consideration.
A floor sink also was incorporated into the room design to ensure proper drainage and to mitigate any slip-and-fall risk associated with mobile whirlpool birthing tubs. The location was reviewed by the design team with the facility managers and LDRP suite staff to ensure the use and maintenance was taken into consideration.
Medical gas casework integration. Integration of the medical gas system was in two areas within each room: at the headwall closest to the patient’s bed and the infant care area.
Doors enclose the medical gas outlets serving the headwall closest to the patient’s bed, which the medical staff can open when needed. It allows for the patient to avoid viewing the medical equipment and connections when she first arrives at the suite.
The medical gas outlets serving the infant care area are within the room but not directly next to the patient’s bed. These outlets are located within the cabinet that staff can open and use at the time of birth to examine the newborn and provide care as necessary. The baby warmer also is concealed within the cabinet. Once the cabinet doors are opened, the warmer and counter slides out, locks into place and is available for use. Then the outlets are accessible to the medical staff to care for the baby.
Through consideration of the facility standards, guidelines and codes, along with integrating ingenuity into the process, the team established a cohesive design. It includes the facility’s desires to incorporate cutting-edge patient care — such as whirlpool birthing tubs and in-room infant care — in a suite design that instead of feeling institutional, offers a warm and inviting place for patients to rest and recuperate.
The requirements of the facility, the authorities having jurisdiction and the applicable codes are most important to keep in mind when designing a space within a health-care facility. LDRP suite design blurs the line between institutional and hospitality. The need to have a calm, healing environment for the patients is driving the future of this area of design. With that thought in mind, health care as a whole will be shifting to incorporate the patient experience as a pinnacle pillar of consideration of all design decisions.