About GRACE
GRACE unifies two threads: graduate practicum scholarship (“Crisis Not Chaos,” UTMB Galveston, Dr. Sandra Petersen) and executive presentations on surge capacity at a leading hospital in Texas—grounded in the research and clinical leadership of Amy Poso, RN, BSN. Together they keep L&D surge response explicit and measurable so overcrowding is harder to ignore or improvise through. We also situate the product alongside peer-reviewed health-services research on nurse staffing during labor and birth, because sustainable surge response depends on the same reality that literature describes: staffing and flow are structural, not only individual effort.
Research on labor & delivery nurse staffing — Simpson et al. (2023) analyzed survey data from thousands of registered nurses alongside hospital characteristics, reporting variation in adherence to AWHONN nurse staffing guidelines across settings—and discussing implications for equity when gaps concentrate among more vulnerable patients. GRACE does not calculate mandated ratios or replace institutional policy; it helps charge nurses and leaders operationalize a shared surge language, earlier escalation, and auditable playbooks when the unit tightens. Simpson et al. (2023), Nursing Outlook.
Full reference: Simpson, K. R., Spetz, J., Gay, C. L., Fletcher, J., Landstrom, G. L., & Lyndon, A. (2023). Hospital characteristics associated with nurse staffing during labor and birth: Inequities for the most vulnerable maternity patients. Nursing Outlook, 71(3), Article 101960. https://doi.org/10.1016/j.outlook.2023.101960
Frontline input on perinatal staffing guidelines — Simpson et al. (2012) synthesized nurse-identified themes for updating professional perinatal staffing guidelines—highlighting acuity, mother–fetus–newborn care realities, small-unit constraints, and workforce effects. That work complements later health-services findings on guideline adherence and underscores why GRACE emphasizes weighted acuity, surge bands, and shared operational visibility rather than census alone. Simpson et al. (2012), JOGNN.
Full reference: Simpson, K. R., Lyndon, A., Wilson, J., & Ruhl, C. (2012). Nurses' perceptions of critical issues requiring consideration in the development of guidelines for professional registered nurse staffing for perinatal units. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 41(4), 474–482. https://doi.org/10.1111/j.1552-6909.2012.01383.x
Predicting staffing needs in a high-volume L&D unit — Simpson (2015) evaluated whether an AWHONN-based staffing model and guideline-driven gap analysis could predict nurse staffing needs for a large-volume labor and birth service. Reported findings are from one perinatal program, not a multi-site trial of any product. They align with GRACE’s focus: make workload and staffing demand legible early so charge teams can align resources with AWHONN-style expectations—not replace policy or professional judgment. Simpson (2015), JOGNN.
Full reference: Simpson, K. R. (2015). Predicting nurse staffing needs for a labor and birth unit in a large-volume perinatal service. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 44(3), 329–338. https://doi.org/10.1111/1552-6909.12549
Staffing, cesarean rates, and VBAC (hospital-level evidence) — Lyndon et al. (2025) examined relationships between labor nurse staffing adherence and hospital cesarean and vaginal birth after cesarean (VBAC) rates using linked survey and administrative data. Findings are observational and hospital-level; they support the case for staffing accountability—not for attributing birth outcomes to any single tool. GRACE is operational surge and workflow support, not mode-of-birth decision support. Lyndon et al. (2025), Nursing Outlook.
Full reference: Lyndon, A., Simpson, K. R., Landstrom, G. L., Gay, C. L., Fletcher, J., & Spetz, J. (2025). Relationship between nurse staffing during labor and cesarean birth rates in U.S. hospitals. Nursing Outlook, 73, Article 102346. https://doi.org/10.1016/j.outlook.2024.102346
Labor and delivery is a distinct high-acuity environment: induction clusters, surgical schedules, triage-like intake, and boarder patients can all compress capacity at once. GRACE is built for that reality—not generic hospital census alone.
Operational bands (Green → Black) pair AWHONN-aligned definitions with key indicators, immediate actions, and resources—including divisional units, external departments such as ED and lab at higher levels, and phased placement (hallway, PACU, OR, temporary space) before gridlock. Black includes executive assessment for Safe Harbor–style protections with Women’s Services and hospital leadership.
Amy Poso partnered with leadership at a leading hospital in Texas on the surge capacity work that became the backbone of GRACE. Her research and frontline perspective on Labor & Delivery overcrowding—how census, acuity, and patient flow interact across a shift—helped shape the surge matrix, weighted acuity model, and charge-nurse playbooks. That collaboration keeps the software tied to real unit constraints rather than abstract census alone.
GRACE carries that research into a live platform: the surge matrix, real-time shared dashboard, weighted acuity scoring, AI-powered shift debriefs and predictions, EHR integration (HL7 v2, FHIR R4, REST), role-based team management, and configurable email notifications—so charge nurses can track, analyze, and act on every shift.
The paper emphasizes situational judgment: a unit can be ‘black’ on acuity yet still staffed safely, or look calm while throughput risks mount. GRACE encodes indicators and playbooks while preserving the charge nurse’s role in interpreting context and calling the plan.
What the platform delivers today
Every user sees the same live unit state. Room occupancy, acuity scores, surge level, and staffing sync automatically across all connected sessions with no manual save required.
Anthropic Claude interprets the feel of the unit, summarizes room activity, generates structured shift debriefs, and forecasts surge-level changes 2 hours ahead.
A heuristic prediction engine analyzes current acuity trends and room velocity to forecast where the unit will be in 2 hours. Optional email alerts fire when escalation is predicted.
Connect GRACE to Epic, TeleTracking, and other hospital systems via HL7 v2 ADT messages, FHIR R4 resources, or generic REST APIs. Inbound data automatically updates room state and census.
Unit-wide and per-room dashboards show surge-level distribution, acuity heatmaps, nurse-to-acuity ratio trends, and room activity timelines for continuous improvement.
Every room change is logged: admissions, discharges, factor changes, nursing level shifts, and color transitions. A sparkline chart shows each room’s score trajectory over time.
Three roles control access: admins manage team, integrations, and system settings; charge nurses operate the dashboard and run AI tools; viewers observe read-only.
System-wide and per-user notification preferences. Alerts fire on surge-level changes, critical rooms, shift debriefs, prediction escalations, and new team members.
Explore GRACE for your L&D unit.
We’ll walk through the real-time dashboard, AI analysis, EHR integration, and historical trending—grounded in the original patient-safety practicum and adaptable to your hospital.