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Delivery Dates: How Obstetricians Can Collaborate to Advance Patient Care

Delivery Dates: How Obstetricians Can Collaborate to Advance Patient Care
Author Information (click to view)

Nicholas Kulbida, MD

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Nicholas Kulbida, MD (click to view)

Nicholas Kulbida, MD

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The traditional model of Labor & Delivery may not work the way it should, at least over the weekends.

A Baylor College of Medicine study from 2017 found that women who deliver on the weekends – and their babies – are more likely to suffer poor outcomes.

Although the increased risk of death for weekend deliveries was small, the Baylor study also found that weekend deliveries are associated with more maternal blood transfusions and more perineum tearing (neonatal intensive care unit admissions and neonatal seizures also increased on weekends).

The “weekend factor” is due to the greatest threat to maternal and infant health: time.

Hospitals have unique needs in obstetrics based on the variability and unpredictability of labor and delivery. But their foremost consideration is optimal maternal and infant health and safety outcomes. That requires consistent coordination and oversight of emergent situations and uninterrupted patient coverage by an experienced, on-site clinical care team – whether it’s a weeknight, in the middle of the night, or over a weekend.

This can present a challenge for community obstetricians who must balance the practice of medicine with the business of medicine. A private OB/GYN practice requires being available to deliver a baby or handle an obstetrical emergency at any point during the day or night, which requires a rapid, often unanticipated trip to the hospital and hampers the ability to smoothly run a private practice. Over a weekend (when OBs hope to be “off the clock”) the stress is compounded exponentially.

“One Team” Approach

In recent years, more hospitals have engaged OB hospitalists to support the local physicians who serve pregnant women in the community, including overnight and on weekends. OB hospitalists work closely with the community physicians to ensure seamless transition of care, by leveraging best practice protocols to ensure clear, direct communication.

In our experience as the nation’s largest OB hospitalist company, we’ve found that after some initial resistance – based primarily on lack of familiarity with the hospitalist concept, and unlike the way they’ve been trained – community OBs broadly support the use of L&D hospitalists, embracing the “one team” approach to care. And because babies refuse to adhere to work-week schedules to make their appearance, the benefits of OB hospitalists are particularly appreciated on the weekends.

Collaboration Decreases Burnout and Extends Clinicians’ Practices

Community OBs face unique pressures unlike those in many other medical specialties, including the need to be on-call and potentially available 24/7. The pressure of balancing the health and safety of not one, but two vulnerable lives at one time and, due to the risk of failing to respond quickly to that which is unanticipated and unexpected, the constant shadow of a malpractice lawsuit.

Having a hospitalist as backup doesn’t mitigate all of those challenges, but having an OB hospitalist available to handle routine care and rapidly evolving emergencies lessens time out of office away from practice and patients. It also promotes a healthy life balance to decrease burnout and increase the length of a professional practice. This flexible approach benefits both the hospitalist and community practitioner.

A Collaborative Approach Benefits Patient Care

Our data show the impact on patient care and physician liability is significant. Because these physicians are more often exposed to complex deliveries in the emergent situations than a community provider – and because clinicians staff the hospital full-time – OB hospitalists help eliminate the “delay in care” that is associated with 31% of OB claims (22% related to delay in fetal distress, another 9% with delays in delivery). Nationally, our OB Hospitalist programs are associated with significant (60% and more) decreases in adverse events resulting in medical malpractice claims. More recently, a 2016 study identified a 15% reduction in perinatal serious safety events at hospitals where an OBHG program was implemented.

Collaborative efforts between obstetricians yield the best of all possible results on shared goals: the best possible experience by physicians, and the best possible outcomes for patients.

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