Beginnings of an ob.gyn. hospitalist company

I have asked Dr. Christopher C. Swain to write this guest column for Ob.Gyn. Hospitalist STAT!.

As the founder of OB Hospitalist Group (OBHG), a nationally recognized ob.gyn. hospitalist company, I’m frequently asked to describe the event that led me to its beginning. However, it wasn’t just one striking event, but a series of compounding issues and strains experienced as a private practicing physician that led me to realize some significant voids in women’s health care – in both the hospital and the private practice.

Those voids were most evident in the high-stress situations of trying to be in two places at once – seeing a patient in the office while a laboring patient experiences an unforeseen emergency at the hospital. They were also apparent during nights filled with phone calls, or during a child’s ballgame with a beeper going off right before their big moment.

These voids weren’t just experienced by me or my partnering physicians, but by the hospitals themselves. Unscheduled patients presenting to the hospital in the first half of pregnancy were seen in the emergency department by an emergency physician. Patients seen in the second half of pregnancy were considered too high-risk for the emergency department, so they were sent to the Obstetrics Triage Unit where they were often evaluated only by a nurse, and not a physician, before being discharged. Astonishingly, the Obstetrics Triage Unit was the only place in the entire hospital where unscheduled patients were allowed to be discharged without being physically evaluated by a physician.

As an ob.gyn. physician, one of my biggest fears was that I would be unable to be where I needed to be, when I needed to be there. I came to believe (hope?) that there had to be a better and safer way to do some of the things we do. I suspected I was not alone in my experiences and, as it turns out, I was certainly not.

In 2006, I started OBHG in hopes of helping private physicians and hospitals fill some of the voids that I had experienced for so many years. The ob.gyn. hospitalist model that evolved, and that OBHG has implemented in more than 50 hospitals to date, is one that focuses on each and every pregnant patient that presents to the hospital, and provides much-needed support for private ob.gyn. physicians. The group currently employs more than 250 ob.gyn. physicians.

The OBHG hospitalist model takes into consideration the fact that patients want and expect to be delivered by their own physician; and private physicians want and need to deliver these patients to sustain their practices. The ob.gyn. hospitalist is not a replacement for the private ob.gyn. physician, but an extension of the private ob.gyn. practice that can be utilized in times of need.

The ob.gyn. hospitalist is an emergency responder who will react to any obstetric or gynecologic emergency within the hospital. Additionally, there are other core functions in most OBHG programs, including the management of the obstetrics triage unit, evaluation and management of unassigned obstetric patients, and management of any unassigned gynecology patient requiring urgent care from an ob.gyn. specialist.

Most ob.gyn. hospitalist programs provide additional support services for local physicians to assist or manage patients in labor, often including VBAC management, supervising oxytocin augmentation, ordering epidurals, amniotomy, placement of fetal scalp electrode, evaluation of bleeding, and review of questionable tracings. In this scenario, the private physician at home or in the office continues to be the "captain of the ship," with the ob.gyn. hospitalist playing a supporting role.

The ob.gyn. hospitalist model provides hospitals with 24/7 in-house coverage by experienced, board-certified ob.gyns. This increases patient safety, improves patient and staff satisfaction, helps community physicians achieve the optimal work/life balance, and, most importantly, saves lives. Saving lives of women and their newborns has become the mantra by which our team lives each and every day. It is what drives OBHG to continuously grow, improve, and expand its ob.gyn. hospitalist programs.

Guest editorialist Dr. Swain is the founder, president, and chief medical officer of OB Hospitalist Group. OB Hospitalist Group (www.obhg.com) is a medical group specializing in the development and operation of ob.gyn. hospitalist programs.