Impact of an Obstetrical Hospitalist Program on the Safety Events in a Mid-Sized Obstetrical Unit

The Role of the Obstetrics and Gynecology Hospitalist in the Changing Landscape of Obstetrics and Gynecology Practice

As the field of obstetrics and gynecology (Ob/Gyn) evolves, the role of the Ob/Gyn hospitalists has become increasingly integrated into the framework of the specialty. Ob/Gyn hospitalists take on essential responsibilities as competent clinicians in emergent situations and as hospital leaders: maintaining standard of care, collaborating with community practitioners and care teams, promoting diversity, equity, and inclusion practices, and contributing to educational initiatives. The impact of the Ob/Gyn hospitalists is positive for patients, fellow clinicians, and institutions. As the field continues to change and the Ob/Gyn hospitalist develops as an established subspecialty, further research evaluating its role remains essential.

The Obstetrics and Gynecology Hospitalist: Risk Management Implications

The concept of a 24/7 in-house obstetrician, serving as an obstetrics and gynecology (Ob/Gyn) hospitalist, provides a safety-net for obstetric and gynecologic events that may need immediate intervention for a successful outcome. The addition of an Ob/Gyn hospitalist role in the perinatal department mitigates loss prevention, a key precept of risk management. Inherent in the role of the Ob/Gyn hospitalist are the important patient safety and risk management principles of layers of back-up, enhanced teamwork and communications, and immediate availability.

The obstetrical emergency department: need, rationale, and guide to implementation

The past 2 decades have seen dramatic growth in the number of obstetrics and gynecology hospitalists, and many hospitals have created obstetrical-specific emergency departments. The goals of an obstetrics emergency department are to provide safe and efficient care to the pregnant dyad and postpartum patient, while generating revenue for emergency services provided. In an obstetrics emergency department, all patients must be evaluated in person by a licensed practitioner, whereas historically they may have been evaluated in person by nursing staff or a trainee. We make the argument that formation of an obstetrics emergency department has the potential to improve the safety and quality of patient care. In addition, the financial benefits to institutions are substantial and can subsidize the cost of maintaining obstetrician presence all the time in the hospital. There are various regulatory requirements to become certified, accredited, and licensed as an emergency department. In addition, there are many operational and systems issues that institutions should consider before implementation. We provide a guide for healthcare systems considering creating an obstetrics emergency department.

Use of Obstetric and Gynecologic Hospitalists Is Associated With Decreased Severe Maternal Morbidity in the United States

OBJECTIVES

This study aimed to evaluate the prevalence of obstetric and gynecologic (Ob/Gyn) hospitalists and determine if an association exists between the presence of Ob/Gyn hospitalists and severe maternal morbidity (SMM).

METHODS

This observational study included data from hospitals listed in the USA TODAY 's 2019 article titled, "Deadly deliveries: Childbirth complication rates at maternity hospitals." Telephone and email surveys of staff in these hospitals identified the presence or absence of continuous providers in the hospital 24 hours, 7 days a week (24/7 coverage) and the types of providers who are employed, then compared these responses with the SMM cited by USA TODAY .

RESULTS

Eight hundred ten hospitals were contacted, with participation from 614 labor and delivery units for a response rate of 75.8%. Fifty-seven percent of units were staffed with 24/7 coverage, with 46% of hospitals' coverage primarily provided by an Ob/Gyn hospitalist and 54% primarily by a nonhospitalist OB/Gyn provider. The SMM and presence of 24/7 coverage increased with the level of neonatal care and delivery volume. Of hospitals with 24/7 coverage, those that primarily used Ob/Gyn hospitalists had a lower SMM for all mothers (1.7 versus 2.0, P = 0.014) and for low-income mothers (1.9 versus 2.30, P = 0.007) than those who primarily used nonhospitalist OB/Gyn providers.

CONCLUSIONS

Severe maternal morbidity increases with delivery volume, level of neonatal care, and 24/7 coverage. Of hospitals with 24/7 coverage, units that staff with Ob/Gyn hospitalists have lower levels of SMM than those that use nonhospitalist Ob/Gyn providers.

The workload of obstetric doctors working in different modes at a medical center

Objective:

The workload of obstetric and gynecologic (OB-GYN) physicians has been an unprecedented increase because of the decrease in the number of such physicians. This study aimed to demonstrate that the hospitalist mode was the best mode for the work-life balance of OB-GYN physicians.

Materials and Methods:

This was a retrospective study in a tertiary academic hospital. Patients were admitted to the labor ward for delivery. The number of deliveries performed by each OB-GYN physician in different working modes was measured. We reviewed the medical charts of women admitted for delivery as well as the shift schedule of OB-GYN physicians from January 1, 2018, to June 30, 2018. We classified deliveries into three modes: the traditional mode (patient designation), on-call mode, and the hospitalist mode. Traditional mode was the work mode currently. On-call mode and the hospitalist mode were simulated conditions. The number of deliveries and the total OB-GYN physician worked time for their shift were recorded. The differences between the three modes and between OB-GYN physicians were assessed using analysis of variance.

Results:

In total, 237 deliveries were recorded over 6 months (3 deliveries were excluded from our data); these deliveries were performed by four OB-GYN physicians named A to D. Significant differences in workload were noted between OB-GYN physicians working in the traditional mode and those in the on-call mode, but no significant differences were noted among those working in the hospitalist mode. All OB-GYN physicians worked an average of seven shifts, and no significant differences among them were noted.

Conclusion:

The hospitalist mode might be the optimal mode for OB-GYN physicians to achieve a favorable work-life balance if their original main jobs are obstetric practice.