The Society of OB/GYN Hospitalists Takes Off

Did you know that the Society of OB/GYN Hospitalists is holding its second annual clinical meeting on Sept. 27-29, 2012, in Denver? Did you know that the Society of OB/GYN Hospitalists (SOGH) even existed? With more than 100 paid founding members, SOGH is not yet widely known within the ob.gyn. community; however, it did not emerge overnight.

Formally established in 2011, it came about due to a group of like-minded and dedicated ob.gyn. hospitalist volunteers who, like me, wanted to create a formal community that would address our specific needs, answer our particular questions, and reinforce, bolster and support our emerging position of influence in ob.gyn. hospital care.

With the concept of the “ob.gyn. hospitalist” widely embraced only since 2003, I wasn’t sure how many other physicians were practicing this model of ob.gyn. care. I was certain I wasn’t alone, so in 2008 I launched my website ObGynHospitalist.com [now obgynhospitalistconsulting.com] to make sure. It was a fairly “homemade” effort at first, but approximately 175 ob.gyn. hospitalists of varying descriptions joined my site in its first 2 years. I had gathered together a community of disconnected, somewhat frustrated, and often isolated hospitalists who were motivated to connect and exchange answers with one another.

As the number of members grew, and the website became the only professional resource for ob.gyn. hospitalists, there was increasing interest in getting together in person. In 2010, I requested that the American College of Obstetricians and Gynecologists (ACOG) allow us to hold a Special Interest Group meeting at its annual clinical meeting (ACM) in San Francisco. I was thrilled that more than 75 people showed up and a lively discussion of hospitalist-specific issues clearly showed that there was a need for a more formal organization to be formed.

An organizational meeting was held in Denver in October 2010 with 17 people in attendance. A pivotal moment at that meeting was when Dr. Larry Wellikson, the Society of Hospital Medicine’s CEO, gave us invaluable advice on how to form a nonprofit medical society.

A second Special Interest Group meeting was held at the 2011 ACOG ACM in Washington, D.C. This provided the impetus and the volunteers to start organizing the society’s first ACM. In September 2011, it all came together. With 43 enthusiastic ob.gyn. hospitalists, generalists, and administrators in attendance, SOGH was officially born.

Cochaired by Dr. Karenmarie Meyer and myself, the conference covered a range of important clinical and business issues that affect ob.gyn. hospitalists. Presentations included best practices in obstetric triage and evidence-based cesarean section techniques. Data collection techniques, safety and malpractice issues, and ob.gyn. hospitalists’ core competencies also were discussed. The SOGH board of directors was elected. Volunteers signed up for four separate committees, and committee chairs were elected.

Following the ACM, The Doctors Company conducted a first-of-its-kind Obstetrical Emergency Simulation Workshop. One of the highlights was the attendance of Prof. Christopher B. Lynch, who flew in from the United Kingdom to personally demonstrate his B-Lynch suture. He will again be in attendance for the simulation workshop on Sept. 27, 2012.

Last month SOGH achieved another milestone with the launch of its website SocietyofOBGYNHospitalists.com, which is where you can find this year’s ACM schedule and registration form, as well as SOGH membership applications.

As SOGH’s outgoing founding president, I’m proud to have overseen its inception, birth, recognition as a nonprofit 503(c)3* organization, and the preparation for the second ACM. Dr. Meyer takes over as president after the ACM, and I look forward to watching it mature in the years to come.

Originally posted AUGUST 17, 2012 on ehospitalistnews.com

Introducing Two Leaders – OBGYN Hospitalist Field

This month I’d like to introduce you to two leaders in the ob.gyn. hospitalist field.
The first is Dr. Wayne Farley of Questcare Obstetrics, based in Dallas. It currently has ob.gyn. hospitalist programs in Texas, but has recently expanded to Colorado.

Questcare’s first program was established 5 years ago, and in 2008, Dr. Farley stated: “I’m sure the face of our ob.gyn. hospitalist programs will look much different in 2012-2013.” That vision has proven to be very true, and he still believes that Questcare’s programs will continue to evolve with time.

Dr. Wayne Farley

Dr. Farley attributes the program success of Questcare to its focus on the development of perinatal service lines that the facility could not otherwise support. In fact, they have successfully created a variety of these programs for the facilities with which they are currently contracted and hope to expand them in their future contracts.
Questcare Obstetrics is currently expanding perinatal service lines to include high-risk obstetric referral centers. Even more specialized is the Advanced Maternal & Newborn Institute and Specialty Obstetrics Referral Center at Medical City Women’s/Medical City Children’s Hospital in Dallas. This program offers patient-focused outpatient and inpatient care of pregnancies complicated by fetal anomalies and/or chromosomal aberrations.
In addition to high-risk referral centers and specialty clinics, Questcare also has facilitated the development and implementation of a successful maternal transport program.

With this evolutionary change in Questcare’s ob.gyn. hospitalist programs in just 5 years, it should be interesting to see what the next 5 years bring. Questcare Obstetrics is focusing on providing quality ob.gyn. hospitalist programs, while helping expand targeted service lines for its contracted hospitals.

The development of these programs may seem out of the realm of what ob.gyn. hospitalist programs normally bring to a facility, but Questcare’s programs have brought a significant value-added contribution to the hospital without adding to the overall costs of healthcare.

The second person I’d like to introduce is the current president of the Society of OB/GYN Hospitalists (SOGH):

Dr. Karenmarie K. Meyer

Dr. Meyer is a great advocate of the ob.gyn. hospitalist model, and her goals for the fledgling society include defining what an ob.gyn. hospitalist actually is, delineating the criteria for hospitalist core competency; championing patient safety for women in the hospital, emergency department, and in the labor and delivery setting specifically; adding simulation training as part of our core skill set; and documenting our results through research and publications. Dr. Meyer has led significant progress in all of these areas and SOGH has been recognized as an organization whose members will take the lead in determining how ob.gyn. hospital care is provided in the future.

Passionate about the broadening understanding of the model, Dr Meyer recently stated: “Ob.gyn. hospitalists are much more than just an ‘in-house’ doctor available for emergencies. As our membership and visibility continue to increase, others are realizing this as well. Our members are up to date on current management protocols, and our availability to private physicians and their patients has been well recognized in hospitals utilizing our practice model. Our knowledge, consistency, and reliability will continue to define us as the ‘state of the art.’ ”

Dr. Meyer and SOGH are continuing to identify hospitalists’ core competency criteria and how these will be assessed and certified. SOGH also has been asked to help define the core criteria for the first fellowship in an ob.gyn. hospitalist discipline, which is being offered by Dr. Anthony Vintzileos at Stony Brook in N.Y.; the fellowship will be established at Winthrop University Hospital, Mineola, N.Y. The second program will be at the Fountain Valley Regional Hospital associated with the University of California, Irvine.

As the ob.gyn. hospitalist model matures and changes, Dr. Farley’s and Dr. Meyer’s contributions are exciting and are helping to define and drive the future of women’s inpatient care across the country today.

Originally posted MAY 21, 2013 on ehospitalistnews.com

The Impact of Hospitalists on Gynecologic Emergencies

Up to now, I have been commenting mainly on ob.gyn. hospitalists’ impact on labor and delivery, but our surveys show that the majority (64%) of ob.gyn. hospitalists also have responsibility for seeing gynecologic patients in the main emergency department as well as inpatient consultation.

Most gynecologic emergencies are as you would suspect: threatened miscarriage, ectopic pregnancy, pelvic inflammatory disease, and, to a lesser extent, torsion of benign tumors as well as the occasional malignancy, and the common vague abdominal pain syndromes. Ob.gyn. hospitalists provide the main emergency department with the type of service that they provide in labor and delivery (L&D) triage or the obstetric ED: immediate or at least rapid response, expert clinical care, and the ability to work with the team in the ED or with other team members such as surgeons in the case of major trauma involving either pregnancy or gynecologic organs. This rapid response results in increased patient satisfaction as well as a more efficient ED.

However, having an ob.gyn. hospitalist cover the ED comes at a cost, as it physically takes him or her away from covering potential emergencies in the L&D area. Some hospitals get around this problem by allowing the ob.gyn. hospitalist to only go to the ED when they’re unoccupied; or if they make a diagnosis requiring surgery, they will call the on-call gynecologic surgeon so that the ob.gyn. hospitalist is not in the operating room with a case just when they’re needed for a shoulder dystocia or prolapsed cord in L&D.

This compromise of allowing diagnosis but not surgical treatment is a good one because even though the main ED is frequently geographically separate from L&D, the ob.gyn. hospitalists can usually rapidly leave the main ED to respond, while they could not provide the same response if they were in the middle of a surgical case. Having a backup gynecologic surgeon on call also provides a mechanism for outpatient follow-up for a medically treated gynecologic emergency patient.

Well-run programs also have an obstetric physician on backup call for follow-up of unassigned outpatient obstetric patients who need to be seen after triage or obstetric ED visits. More importantly, these programs have a backup physician if the ob.gyn. hospitalist gets either too busy or too fatigued. However, our most recent ob.gyn. hospitalist.com employment survey shows that between 35% and 45% of programs do not have an adequate emergency backup system in place to cover the hospitalists (www.obgynhospitalist.com) [now obgynhospitalistconsulting.com].

Rapid and easily obtained gynecologic consultation also helps with improved patient care, diagnosis, treatment, and turnover of inpatient beds. With in-house ob.gyn. hospitalists, the days of internists, family practitioners, and traditional hospitalists having to wait until after office hours for a gynecologist to see an inpatient are over. Traditionally, that consultation would take place at 6 p.m. or 7 p.m., and then additional ordered diagnostic imaging might not take place until the next day, adding unnecessary delays in diagnosis and causing longer hospital stays than necessary.

Gynecologic responsibilities add to the body of knowledge that ob.gyn. hospitalists need to be skilled at, especially with diagnosis and medical treatment. However, requiring hospitalists to provide gynecologic coverage also emphasizes the potential challenge of how to maintain superb gynecologic surgical technique. This is difficult with low volumes of surgical cases. Once again, this problem can be eliminated if there’s a gynecologic surgeon to do the work in the operating room. This is also an area that is of particular interest to the Society of OB/GYN Hospitalists as they discuss and decide which skills and competencies hospitalists must possess and maintain.

Originally posted FEBRUARY 14, 2013 on ehospitalistnews.com

How are Ob.Gyn. Hospitalists Different from General Ob.Gyns.?

The only difference between ob.gyn. hospitalists and general ob.gyns. is work location, right? We all undergo the same residency training, pass the same boards to become board certified, and you have to be a general ob.gyn. to become a hospitalist after all. So, in one sense, there are no differences.

In addition to clinical skills, however, hospitalists do differ. As I outlined in my column “Ob.Gyn. Hospitalist Character Traits,” a hospitalist must be a seasoned professional and a team player, be willing to serve, inspire trust, be a good communicator, and be trained and incentivized to implement system-wide improvements.

Along with character traits, it is generally acknowledged that ob.gyn. hospitalists possess a specific set of core competencies. I began trying to formally define these during my first American College [now American Congress] of Obstetricians and Gynecologists annual clinical meeting (ACM) clinical seminar in 2010.

Dr. Bob Fagnant expanded on the initial ideas in a presentation at the second Ob.Gyn. Hospitalists’ special interest group meeting at the 2011 ACOG ACM in Washington, D.C. His presentation was well received, drew much interest from a large audience, and has initiated discussion that continues. The Society of Ob.Gyn. Hospitalists (SOGH) also has dedicated itself to defining the core competencies, but as this is such a new model of ob.gyn. practice, there is much yet to be debated, and discussion should be expected and encouraged.

As stated above, the ideal hospitalist should be a seasoned professional. ObGynHospitalist.com employment surveys from the past 2 years showed that only 7% of ob.gyn. hospitalists started hospitalist work within 5 years of completing their residency. I think all of us agree that it is very difficult for a new residency graduate to acquire the skills and experience to step in and perform as a hospitalist. Not to say that it’s impossible, just very difficult in light of most residency volumes combined with residency hour restrictions.

One idea that I have heard several academic centers beginning to discuss is that of a fellowship for ob.gyn. hospitalists. Advanced training in a fellowship could provide more experience for new graduates, but it would be especially helpful for experienced, board-certified ob.gyn. hospitalists to hone not only their clinical skills, but also learn the administrative, simulation teaching, team leadership, and information management skills to take existing hospitalist programs from good to great and to start new programs at the highest skill level.

This idea is in its infancy and faces obstacles. Most experienced ob.gyns. may be unwilling to leave their current private practice positions and return to the lifestyle, hours, and, especially, the payoff of a fellow. However, there may be creative solutions similar to executive MBA programs, such as online learning, reviewing curricula designed by the academic center, and periodically traveling to the center for weekends or more prolonged times for the hands-on clinical training and experience portion over a year or two. Introduction of a new additional program needs to be handled carefully because such a program for hospitalists cannot reduce or take away from the clinical training experience of current residents and maternal-fetal medicine fellows.

Like the development of the core competencies necessary for ob.gyn. hospitalists, it will be fascinating to watch the development of academic programs for ob.gyn. hospitalist fellows. It will be exciting to see the first graduates and even more exciting to see the first board-certified ob.gyn. hospitalist in a new subspecialty. Will an old hospitalist like me get grandfathered in if I can pass the new (yet to be determined) American Board of Obstetricians and Gynecologists’ board certification for ob.gyn. hospitalists?

We are lucky to have the SOGH in a position to hear discussion and debate and to advocate for commonly agreed-upon positions. There are so many questions to answer to define the difference between general ob.gyns. and hospitalist ob.gyns., but we are on the cusp of not an evolution in care for women in the hospital, but a revolution. The future is unknown, but the direction from the known is extremely positive. Not only is patient care becoming safer, but the system is becoming safer and more cost efficient while at the same time improving the lifestyle of the general ob.gyn. practitioner. This last sentence will be backed up by data and experience in the near future, I predict.

Originally posted JANUARY 18, 2013 on ehospitalistnews.com

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

How are ObGyn Hospitalists Different from General ObGyns?

The only difference between ob.gyn. hospitalists and general ob.gyns. is work location, right? We all undergo the same residency training, pass the same boards to become board certified, and you have to be a general ob.gyn. to become a hospitalist after all. So, in one sense, there are no differences.

In addition to clinical skills, however, hospitalists do differ. As I outlined in my column “Ob.Gyn. Hospitalist Character Traits,” a hospitalist must be a seasoned professional and a team player, be willing to serve, inspire trust, be a good communicator, and be trained and incentivized to implement system-wide improvements.

Along with character traits, it is generally acknowledged that ob.gyn. hospitalists possess a specific set of core competencies. I began trying to formally define these during my first American College of Obstetricians and Gynecologists annual clinical meeting (ACM) clinical seminar in 2010.

Dr. Bob Fagnant expanded on the initial ideas in a presentation at the second Ob.Gyn. Hospitalists’ special interest group meeting at the 2011 ACOG ACM in Washington, D.C. His presentation was well received, drew much interest from a large audience, and has initiated discussion that continues. The Society of Ob.Gyn. Hospitalists (SOGH) also has dedicated itself to defining the core competencies, but as this is such a new model of ob.gyn. practice, there is much yet to be debated, and discussion should be expected and encouraged.

As stated above, the ideal hospitalist should be a seasoned professional. ObGynHospitalistConsulting.com employment surveys from the past 2 years showed that only 7% of ob.gyn. hospitalists started hospitalist work within 5 years of completing their residency. I think all of us agree that it is very difficult for a new residency graduate to acquire the skills and experience to step in and perform as a hospitalist. Not to say that it’s impossible, just very difficult in light of most residency volumes combined with residency hour restrictions.

One idea that I have heard several academic centers beginning to discuss is that of a fellowship for ob.gyn. hospitalists. Advanced training in a fellowship could provide more experience for new graduates, but it would be especially helpful for experienced, board-certified ob.gyn. hospitalists to hone not only their clinical skills, but also learn the administrative, simulation teaching, team leadership, and information management skills to take existing hospitalist programs from good to great and to start new programs at the highest skill level.

This idea is in its infancy and faces obstacles. Most experienced ob.gyns. may be unwilling to leave their current private practice positions and return to the lifestyle, hours, and, especially, the payoff of a fellow. However, there may be creative solutions similar to executive MBA programs, such as online learning, reviewing curricula designed by the academic center, and periodically traveling to the center for weekends or more prolonged times for the hands-on clinical training and experience portion over a year or two. Introduction of a new additional program needs to be handled carefully because such a program for hospitalists cannot reduce or take away from the clinical training experience of current residents and maternal-fetal medicine fellows.

Like the development of the core competencies necessary for ob.gyn. hospitalists, it will be fascinating to watch the development of academic programs for ob.gyn. hospitalist fellows. It will be exciting to see the first graduates and even more exciting to see the first board-certified ob.gyn. hospitalist in a new subspecialty. Will an old hospitalist like me get grandfathered in if I can pass the new (yet to be determined) American Board of Obstetricians and Gynecologists’ board certification for ob.gyn. hospitalists?

We are lucky to have the SOGH in a position to hear discussion and debate and to advocate for commonly agreed-upon positions. There are so many questions to answer to define the difference between general ob.gyns. and hospitalist ob.gyns., but we are on the cusp of not an evolution in care for women in the hospital, but a revolution. The future is unknown, but the direction from the known is extremely positive. Not only is patient care becoming safer, but the system is becoming safer and more cost efficient while at the same time improving the lifestyle of the general ob.gyn. practitioner. This last sentence will be backed up by data and experience in the near future, I predict.

Originally published JANUARY 18, 2013 for clinicalpsychiatrynews.com