obgyn hospitalists

The ABCs of OBGYN Hospitalists

OBGYN hospitalists are generally board-certified obstetrician-gynecologists who focus their practice on hospitalized women and generally do not have an outpatient office. Hospitals hire them for several reasons but the most important is for safety. Especially in obstetrics, the clinical situation can change so rapidly that unless a physician is actually in labor and delivery to respond on an emergency basis there can be a bad outcome for mother or baby or both.

Just like the rapid penetration of internal medicine hospitalists, OBGYN hospitalist programs are spreading. Although a few programs have been around for many years, in 2007 there were only approximately 15 in the United States, and currently there are over 244 with two to six new programs starting up monthly. It certainly is not standard of care yet but I’m predicting it will become standard of care within three to five years. Some people use the word Laborist, but a better term is OBGYN hospitalist for those programs in which there is responsibility not only of labor and delivery, but also of gynecologic emergencies in the main ED (Emergency Department). OB hospitalists only stay in labor and delivery and the private OBGYNs staff the main ED.

Financially speaking, almost all programs lose money. Depending on the volume, that loss can be between $1-$200,000 or up to 1 million dollars. Roughly, a program costs $1.5 million and the income it generates can bring in $500-$750,000 a year. Hospitals with 2000 deliveries or more have a lower amount of loss. It is important to look at a wider budget rather than simply profit or loss because:

  1. Bad outcomes lead to malpractice costs
  2. Hospitalists can increase the volume of high-risk pregnancies that can help to fill up the neonatal ICU, which can be a profit center for hospital
  3. Retention and recruitment of not only physicians but of the expensive-to-train labor and delivery nurses

Many hospitals help pay for the program by transforming their outpatient OB triage areas into OB emergency department (OB ED). This increases the facility fee for evaluation substantially.

Many hospitals are facing the same problems:

  1. OBGYNs do not want to take call
  2. There are unassigned patients
  3. There may be midwives and family practitioners doing deliveries without backup
  4. No one wants to accept the transfer of high-risk patients
  5. Patients wait a long time for evaluation
  6. Maternal Fetal Medicine specialists want to do an outpatient practice only and not come to the hospital
  7. No one wants to do vaginal births after cesarean section (VBACs)
  8. The cesarean section rate is too high

An OBGYN hospitalist can help with all of these issues, making the private practitioners happy by taking the call, caring for the unassigned and high-risk patients, consulting for the family practitioners and midwives, evaluating patients promptly, working collaboratively with the MFM specialist, encouraging VBAC by taking responsibility while the private practitioners stay in their office, and studies prove that having professional full-time OBGYN hospitalists reduces the C-section rate.

There are no great downsides other than the direct costs to the hospital. Initially the private practitioners are skeptical, but within a few months they become the program’s biggest fans. Patients are satisfied and studies prove this. Nurses are supported and empowered. It can become a very important competitive advantage for a hospital that has a nearby competing hospital.

 

What I Learned at the Annual SOGH – Society of OB/GYN Hospitalists

What do you get when you put 83 enthusiastic ob.gyn. hospitalists, generalists, and administrators together in one big conference room in Denver? You get a lot of fun and great, relevant clinical information essential for hospitalists working all across the country today.

Even though I’ve been an ob.gyn. for 35 years and a hospitalist for the last 5, this annual clinical meeting [SOGH – Society of OB/GYN Hospitalists] taught me new business and clinical information. As our model of practice develops, we also can learn much from each other, and this annual event allows us to meet face-to-face to discuss our common problems, share workable solutions, and socialize.

Here were some of the meeting highlights for me:

Dr. Richard Porreco of Rocky Mountain Hospital for Children, Denver, reminded me to respect the condition of placenta percreta, and his expert advice on ways to deal with it was invaluable. He also reviewed peripartum intensive care and discussed the possible future roles for ob.gyn. hospitalists in leading critical care of these patients.

Dr. John Hobbins of the University of Colorado, Denver, explained the use of sonography in labor and delivery, an area that we will all need to pay attention to in the near future. Personally, I only use ultrasound in triage and to identify fetal position in labor, but he showed some of the benefits of using it to assist prior to operative delivery.

Darrell Ranum, J.D., regional vice president of patient safety for The Doctors Company in Columbus, Ohio, covered the factors that result in the delay in treatment of fetal heart rate abnormalities. His conclusion was that communication issues and the delay in the arrival of the physician can both be alleviated by having an ob.gyn. hospitalist on-site. This is something that we still need more data to prove, but his closed claims data was convincing.

Dr. Arthur Townsend spoke about the importance of hospitalist statistics. Collecting statistics is difficult, and hospitalists may not see the benefits. However, Dr. Townsend demonstrated how to make gathering statistics easier with his Web-based solution and the value in doing so, which we need to embrace to prove the difference we make as hospitalists.

Ob Hospitalist Group hosted the lunchtime lecture by Miranda Klassen on amniotic fluid embolism. Miranda, who founded the Amniotic Embolism Foundation (afesupport.org), is not only a survivor, she has made it her mission to educate physicians to identify and rapidly respond to this potentially fatal and often misdiagnosed condition. This was very worthwhile reviewing.

Dr. Stan Davis of Edina, Minn., spoke about the human factors in labor and delivery. He was able to communicate the TeamSTEPPS system in a concise and effective way that made it easier to understand and more relevant for me than all the other times I’ve been exposed to this complex subject.

Dr. John Nelson (nelsonflores.com), cofounder of the Society of Hospital Medicine (hospitalmedicine.org), spoke about starting and operating a professional society, and lessons learned from medical hospitalists so that, hopefully, we can avoid their early missteps.

Prior to the conference, 56 ob.gyns. participated in The Doctors Company’s highly specialized emergency obstetric simulation workshop. One of the highlights of this workshop was the attendance of Professor Christopher B. Lynch, who flew in from the United Kingdom to personally demonstrate his B-Lynch suture technique for the control of postpartum hemorrhage. In addition, GE sponsored a concurrent hands-on ultrasound in labor and delivery course with live models. It was a fantastic mix of learning and practicing old and new skills.

Questcare hosted a welcome reception, which gave attendees an informal chance to meet and discuss problems and solutions related to being hospitalists. This also gave general ob.gyns. who aspire to be hospitalists a chance to ask seasoned hospitalists about their experiences. This is what the annual meeting was all about: networking, talking with peers, and knowing that we are not alone out there practicing this new model of ob.gyn. medicine.
SOGH will hold its third annual clinical meeting in Denver from Sept. 19 to Sept. 21, 2013. Save the date to come and learn more about both the clinical and the business aspects of being an ob.gyn. hospitalist.

Originally posted NOVEMBER 20, 2012 on ehospitalistnews.com