GRACE is the live operating picture for high-acuity shifts on Labor & Delivery. Four color-coded surge bands, weighted acuity per room, AWHONN-aligned staffing, a 2-hour level forecast, and an 8-hour staffing forecast — in one dashboard every charge nurse, manager, and executive sees at the same time.
Field notes and explainers on surge, staffing, and what changes when the unit names the level early — straight from our YouTube channel.
Peer-reviewed nursing research has documented what unstructured surge response costs. GRACE makes the response explicit, shared, and defensible.
A national sample of inpatient maternity RNs found hospital-level variation in reported adherence to AWHONN staffing guidelines, with gaps clustering where patients face higher clinical or social complexity.
Frontline nurses link inadequate perinatal staffing to missed care, potential failure to rescue, and job stress — the exact outcomes a shared surge picture and earlier escalation are built to reduce.
In a linked national sample, stronger labor-nurse staffing adherence was associated with lower hospital cesarean rates and higher VBAC rates — an operational lever executives should be able to see.
GRACE is operational decision support. It does not replace AWHONN standards, employer staffing policy, collective bargaining, or clinical judgment, and it was not evaluated in the studies cited. See the full evidence review →
Every band pairs a clinical definition with specific indicators, immediate actions, and resources that ratchet up by level — turning “it feels heavy tonight” into a shared, documented activation.
Staffing matches volume and acuity per AWHONN. Census below unit maximum across the division.
Activate on-call staff, huddle across units, facilitate discharges, and execute Phase I placement.
Exec notifications fire. Phase II placement and divisional coordination activate. Ratios tracked and documented.
ED, ICU, lab, pharmacy, and executive leadership coordinated. Safe Harbor–style documentation and Phase III placement on the record.
Three promises separate GRACE from whiteboards, group texts, and census dashboards.
Charge desk, manager’s office, on-call phone, executive huddle — same live unit. Room occupancy, acuity, AWHONN ratios, and surge level sync automatically. No save-and-refresh, no parallel spreadsheets.
Every room’s acuity sums weighted clinical factors from the published staffing literature. Nurse capacity is checked against AWHONN 2022 ratios on every refresh. When ratios slip, GRACE shows the deficit in RNs — not vibes.
Surge-level changes, critical rooms, rescue events, and staffing-forecast gaps are logged, timestamped, and routed to the right roles. Activation is defensible, and the next debrief starts with data instead of guessing.
Charge nurses get a live cockpit. Managers get a consistent escalation language. Executives get a scorecard that stops surprising them on the Monday Quality huddle.
Create the hospital account, add rooms, and invite your charge nurses and managers. No PHI required for evaluation — start with synthetic data or placeholders.
Add patients to rooms, apply the 30+ acuity factors, and watch the surge band, AWHONN shortfall, and 2-hour forecast respond live. Training Mode lets you rehearse without touching live data.
Turn on HL7 v2 ADT, FHIR R4, or the REST API when you’re ready. Configure the Job-Role × Notification-Type matrix so the right people get the right alert — and only those people.
GRACE stitches together the operational implications of peer-reviewed nurse-staffing research. Citations link directly to the sources; a fuller tiered list lives on the Evidence page.
Simpson et al. (2023) show hospital-level variation in AWHONN adherence and discuss implications for equity. GRACE surfaces shortfall in real time so adherence becomes operational rather than aspirational.
Simpson (2015) validated that an AWHONN-based model with guideline-driven gap analysis reliably predicts staffing needs in a large-volume L&D unit. GRACE brings that idea to every shift, not only annual planning.
Lyndon et al. (2025) link staffing adherence to cesarean and VBAC rates at the hospital level. Simpson, Lyndon, & Ruhl (2016) document the frontline consequences of short staffing. The same data that helps run the shift builds the quality case upstairs.
GRACE is operational decision support; it was not evaluated in the cited studies and does not replace AWHONN standards, employer policy, or clinical judgment. Browse the full evidence page →
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Read the agreement →Evaluation access is explicitly no-PHI. When you’re ready for Protected Health Information, we execute a companion Business Associate Agreement.
Privacy Policy →Governed under California law with exclusive venue in Los Angeles County. Framework born from leadership work at a leading hospital in Texas with Amy Poso, RN, BSN.
Terms & Conditions →HL7 v2 ADT, FHIR R4, and generic REST — ingest Epic, TeleTracking, and other hospital systems without double entry.
See the product →Free evaluation, no PHI required to start, HL7/FHIR/REST integrations ready when you are. Paid production use and PHI require a separately executed Order Schedule and BAA.
