The reason that hospitals develop ob.gyn. hospitalist programs or hire staffing companies to do it for them is for patient safety. Labor and Delivery handles a plethora of situations: from the straightforward, almost mundane deliveries to the unpredictable emergencies, which can quickly lead to bad outcomes. Frequently, the time it takes for a general ob.gyn., family physician, or midwife to get from home or the office to the hospital can delay treatment.
A recent study by Dr. Larry Veltman and Darrell Ranum of The Doctors Company recommends increased physician readiness as a way to help reduce "delay in treatment of fetal distress" ("Delay in Treatment of Fetal Distress," The Doctor’s Advocate 2012;3rd quarter:8-9).
It’s my experience that having a dedicated, experienced, board-certified ob.gyn. on-site and immediately available can eliminate this delay and often the potential bad outcome.
Ob.gyn. hospitalists are in the best position to directly and immediately affect patient safety while improving efficiency and quality of care. They can start the treatment, such as a crash cesarean section for an abruption, while awaiting the arrival of a private practitioner. This shortened response time leads to better outcomes. This makes common sense, and while there are a multitude of anecdotal examples, we need to conduct more formal studies and collect data to prove this point.
Another great example is from my hospital, where a number of family physicians and midwives have obstetric privileges. In the past, they were vulnerable to being there without backup. They knew that if they had a shoulder dystocia, there would be enough time to ask for help. They were reluctant to call in an ob.gyn., especially in the middle of the night unnecessarily. Now with ob.gyn. hospitalists on-site, they frequently ask me to stand by if they’re worried about possible shoulder dystocia. My approach to this is that I stay outside the labor room door, and if I hear the baby cry I go back to my call room, but if I hear the doctor cry I go in to help.
Private practitioners frequently ask for my help on the interpretation of fetal monitor strips. The private ob.gyns. also discuss difficult cases and specifically ask for surgical assistance on complicated or high-risk cesarean sections. This direct, informal access to experienced ob.gyns. and open communication leads directly to increased patient safety and better outcomes.
The Doctors Company study also stated that improved communications could help address unnecessary delays in "fetal distress" treatment. Hospitalists can help with this, because they are relied upon to integrate and coordinate change when necessary, as they regularly work across the spectrum with neonatologists, anesthesiologists, and others.
Ob.gyn. hospitalists also help the nursing staff: They have the time to stop and talk with the nurses, provide them with immediate and ongoing education, provide immediate patient evaluations in the absence of private physicians, help interpret fetal monitor tracings, and assist in unanticipated situations that often arise. One of our functions is to empower the nurses. Strong, confident nurses who can speak up with their concerns to sometimes intimidating physicians can only make it safer for women in the hospital.
Hospitalists are also a source for implementing hospital protocols, and their constant in-house presence enables them to help advocate for systemwide quality improvement, leading to a safer environment for all patients.
Additionally, when money is the bottom line, increased safety through ob.gyn. hospitalist programs has the potential to offset their expense by reducing the costs associated with investigating and defending malpractice claims. This is good for patients, physicians, and hospitals alike.
Dr. Olson is an ob.gyn. hospitalist in Bellingham, Wash.; founding president of the Society of Ob.Gyn. Hospitalists; and founder of www.obgynhospitalist.com. He is a consultant for ob.gyn. hospitalist programs. E-mail Dr. Olson at [email protected].