Improving Provider Efficiency Through Revised Postpartum Rounding Criteria: A Quality Improvement Study

OBJECTIVE: To determine whether changing a previously arbitrary postpartum rounding cutoff time from 2 AM to midnight improves provider utilization and rounding efficiency without increasing postpartum readmission rates. METHODS: This is a quality improvement project implemented on September 1, 2025, at Kaiser Permanente Santa Clara (KPSC). Post-implementation data were collected from September 1, 2025, to February 28, 2026, from KPSC electronic medical records and survey results completed by KPSC Labor and Delivery providers, including resident physicians, attending physicians, and certified nurse-midwives (CNMs). The total number of patients who delivered between midnight and 2 AM during this timeframe was compared with the number of patients who delivered between midnight and 2 AM and were discharged on postpartum day 0. The average provider rounding time was then multiplied by the number of patients who delivered between midnight and 2 AM and were not discharged on postpartum day 0 to determine the total rounding time saved by this intervention. Postpartum readmission rates were assessed as a balancing measure. RESULTS: Post-implementation data revealed a total of 2,001 deliveries during the 6-month study period. Of these, 223 deliveries occurred between midnight and 2 AM, and only 9 patients (4.0%) were discharged home on postpartum day 0. Provider survey results demonstrated an average rounding time of 20.96 minutes for residents (n=24), 18.13 minutes for attending physicians (n=24), and 17 minutes for CNMs (n=1). Given inconsistent CNM rounding coverage, average provider rounding time was calculated by combining average resident and attending physician rounding time, for an average total provider rounding time of 39.09 minutes per patient. During the initial 6-month post-implementation period, the revised cutoff eliminated 214 routine postpartum rounding encounters, collectively saving 8,365.26 minutes, or 139.42 hours, of provider rounding time. No increase in postpartum readmission rates was observed during this period. CONCLUSION: Changing a previously arbitrary postpartum rounding cutoff time from 2 AM to midnight improved provider rounding utilization and efficiency without an observed increase in postpartum readmission rates. This simple workflow change reduced low-yield rounding encounters and allowed provider time and energy to be reallocated to other clinical responsibilities. Previously established hospital rules and guidelines should be reassessed at regular intervals to identify opportunities for meaningful quality improvement.