OB hospitalist programs: Growth, unexpected benefits and how to implement your own

Women's and children's healthcare services are vastly expanding in hospitals throughout the nation.

In the time since the term hospitalist was first mentioned in a 1996 article by Robert Wachter, MD, and Lee Goldman, MD, in The New England Journal of Medicine, it has noticeably caught on, according to Wayne L. Farley Jr., DO, the CMO of women's and children's services for Dallas-based Questcare, a partner to EmCare, co-located in Dallas, and an affiliate of Greenwood Village, Colo.-based Envision Healthcare. From the introduction of that term and more importantly of the concept of hospital medicine, a plethora of hospitalist subspecialties have emerged. One subspecialty that is making noticeable improvements in patient care and safety is OB hospitalists.

"Even though it's young and still in its infancy stages, the growth has been quite incredible, and we expect it to continue along that route," Dr. Farley said during a webinar sponsored by EmCare and hosted by Becker's Hospital Review.

OB hospitalists offer numerous services and benefits, chief among them immediate availability of emergency deliveries and C-sections. They also conduct patient evaluations and inpatient consults, manage unassigned labor and delivery drop-in patients, and facilitate post-partum and newborn discharges. Overall, OB hospitalists coordinate care with the wider care team — from certified nurse midwives to antepartum and postpartum units to the emergency department.

When Questcare launched its OB hospitalist program approximately eight years ago, it anticipated seeing various benefits from the program — and it has. Not only have patient safety indicators improved and patient length of stay decreased, but satisfaction scores among nurses, administrators and physicians have increased. The program has also resulted in a number of additional benefits, including an expanded knowledge base in the labor and delivery department, reduced stress among physicians and lower hiring, training and malpractice costs.

These benefits are all the more striking when placed alongside data from a May 2015 Contemporary OB/GYN article:

  • 40 percent percent of National Perinatal Information Center/Quality Analytic Services hospitals use OB hospitalists
  • OB hospitalist programs can facilitate a 15 percent reduction in the likelihood of a C-section.
  • OB hospitalist programs can create a 95 percent estimated reduction in direct liability payments.
  • OB hospitalists can help hospitals increase volume of deliveries.

There's no denying OB hospitalist programs are on the rise, but will they become a principle facet of 21st century hospitals?

"We do believe that the standard of care for the future will be OB hospitalists," said Dr. Farley. He predicts OB hospitalist programs will evolve into three specialties: inpatient OB, outpatient OB/GYN and gynecological surgery. Other trends — such as a decrease in C-section rates, fewer unattended deliveries and a decrease in malpractice claims — will also continue, according to Dr. Farley.

However, growth isn't always easy. An OB hospitalist program wrought with issues can negatively affect hospital performance, and numerous factors contribute to a program failing. Without experienced physicians and proper training, a hospital's attempt at an OB hospitalist program can flop.

Therefore, EmCare in partnership with Questcare developed a six-pillar model for running a successful OB hospitalist program.

1. Outstanding people. The physicians and medical staff involved are the biggest determinant of whether a OB hospitalist program thrives. Physicians involved should be Board-certified in OB/GYN, with plenty of high-risk OB/GYN experience. In addition, they should be flexible with the nuances of the program and dedicated to promoting continuous education among other physicians and staff. "The physicians really need to be engaged with the goals of the program and committed to fostering long-term relationships," Dr. Farley said.

2. A specific strategy. Before implementing a program, "[y]ou need a plan," Dr. Farley said. The plan should focus on improving the quality of care, patient safety and clinical outcomes. There are a variety of models — including 24/7 models and hybrid models — a hospital can use, but the model should include a focus on data, performance goals, dashboards, management reports and independent practice audits.

3. Quality patient care. To conduct a successful program, a hospital needs to implement evidence-based procedures and protocols and conduct routine clinical risk assessments. Moreover, the policies need to be standardized throughout the health system, even if programs are functioning at different hospital locations. Each program should have a commitment to exceeding standards in OB/GYN performance metrics.

4. Great services. An OB hospitalist program should provide above-average patient services that are always available and convenient. Each program should strive for continuous improvement in quality care and safety. In addition, education and training in team skills and through simulation labs are crucial to enhancing services. "Communication is the key to making that work," said Dr. Farley.

5. Effective marketing. An OB hospitalist program is a marketable offering in and of itself, especially now that programs are on the rise. "The public is becoming very aware of OB hospitalist programs," said Dr. Farley. "Up until three years ago, the term was virtually unknown, even to OB/GYNs."

Hospitals can use different tactics to market the program to patients and physicians. While key messages to patients should convey that OB hospitalists are Board-certified OB/GYN physicians who are in-house 24/7 to facilitate care, key messages to physicians should include how OB hospitalists help alleviate the burden of covering call, improve productivity, and prevent burnout.

6. A sound financial plan. A hospital must create a well-defined financial plan before implementing an OB hospitalist program. First and foremost, the plan should take the patient population and most common types of procedures into account. It should also focus on how to grow services and better contract with payers. Hospitals should also weigh the benefits of an outsourced OB hospitalist program versus maintaining it in-house.

No matter how a hospital wants to implement an OB hospitalist program, staff engagement, striving for improvement and communication are keys to success. "To assess a program's strengths and weaknesses and assure future success, the OB hospitalist group must place a priority on communication," said Dr. Farley.

To view the webinar, click here.

To view the webinar's slides, click here.

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