ObGyn Hospitalists 101 – What does a hospitalist do?

The term “hospitalist” is commonly thought of as an internist or pediatrician model. However, in 2003, Dr. Louis Weinstein, professor and former chair of obstetrics and gynecology at Thomas Jefferson University Hospital, Philadelphia, proposed the idea of hospital-based obstetricians primarily to improve patient safety.

While there are various evolving models for what type of care an ob.gyn. hospitalist provides, he or she is generally considered to be a board-certified ob.gyn. who is physically present in the hospital, primarily in labor and delivery, although some programs require coverage of gynecology in the emergency room.

The ob.gyn. hospitalist is there for safety: They cover triage, labor, delivery, and postpartum care for all unassigned patients, as well as for those patients signed out to them by a private practitioner. They commonly assist at cesarean sections, respond to almost all true emergencies, and do consults and operative deliveries for family practitioners and midwives. Frequently, they are asked to stand by for deliveries while the private practitioner makes their way in from home or the office. On request, they also perform procedures such as artificial rupture of members (AROM), bedside ultrasound for position, and insertion of pressure transducer catheters.

While it may be obvious, there is evidence-based data which proves that hospitals with ob.gyn. hospitalists have an increased level of safety, which directly leads to a decrease in bad outcomes and subsequent medical malpractice costs. An excellent example is that an ob.gyn. hospitalist can begin a cesarean section for a prolapsed cord before a private practitioner can be there. When they do arrive, the private practitioner can take over the surgery, and the hospitalist can assist as required or requested.

In addition to clinical work, hospitalists teach, run simulations, and are leaders in implementing systemwide changes that increase patient safety, quality, outcomes, satisfaction, teamwork, and overall departmental improvements. They reduce the problems of fragmented care, may work as perinatology extenders, and are immediately available for any situation that arises.

There also are other unintended benefits of ob.gyn. hospitalists. Clinical decision waiting time is reduced, communication is increased, nurses can obtain immediate evaluations and recommendations, and hospital administrators can use them as a tool for marketing to patients as well as recruiting and retaining physicians and nurses.

Ob.gyn. hospitalists also facilitate an improved personal-professional lifestyle balance for general ob.gyns. and family physicians. Ob.gyn. hospitalists allow them to stay in the office or surgery when needed or sign out patients when fatigued or when they simply wish to take a vacation.

I have been an ob.gyn. hospitalist since leaving my solo general ob.gyn. practice in 2007. At that time, I could only identify 10-12 programs within an emerging ob.gyn. hospitalist subspecialty. Now there are over 150 programs across the United States, with one to two new programs emerging each month. My website, ObGynHospitalist.com, was established to provide a professional resource for ob.gyn. hospitalists, where over 800 registered members can access new opportunities, and a forum to exchange ideas and discuss all aspects of our fledgling subspecialty.

In September 2011, the nonprofit Society of Ob/Gyn Hospitalists (SOGH) was established. It now has over 60 paid members, and I am honored to be its founding president.

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