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Tuesday, April 17, 2012

Sarasota Memorial Hospital Introduces OB Hospitalist Program

At yesterday's Sarasota Memorial Healthcare System Public Hospital Board meeting, Dr. John Sullivan and Dr. Greg Damery presented the new obstetric hospitalist model, instituted at Sarasota Memorial Hospital two weeks ago.

According to the American College of Obstetrics and Gynecology, an OB hospitalist, sometimes called a laborist, is employed by a hospital to care for laboring patients and to manage obstetric emergencies. At SMH, this new system will provide for an Obstetric Emergency Department, whereby a pregnant patient admitting to the hospital at 18 weeks gestation or greater is seen by the OB hospitalist rather than triaged through the traditional Emergency Room. Hospitalists will also provide backup to patients' private OB's, and treat patients who are unassigned as well as (assumedly) those who transfer from out-of-hospital care. There will be eight hospitalists on staff at SMH, rotating in 24 hour shifts. They will be paid on an hourly basis, rather than on a fee-for-service basis; proponents of this model, like Dr. Sullivan, say that this will eliminate any bias based on a woman's payment abilities or insurance plan.

The major benefits of the model, according to Dr. Sullivan and Dr. Damery, are improved patient safety and satisfaction, 24/7 OB/GYN physician coverage, reduced patient wait times / overflows, consistent care for unassigned and indigent patients, and rapid response for emergency care. Additionally, hospital proponents say that the service pays for itself, and that hospitalists implement measures which generate additional revenue. We are exploring that facet of the model. Other benefits to the system from a physician's point of view are relief from the pressures of private practice (for those practicing solely as a hospitalist), more predictable schedules, competitive compensation, paid benefits, and guaranteed time off. Cited benefits to the hospital include enhancement of patient safety and an increased level of nursing satisfaction because a health care provider is always present and available.

One possible disadvantage of this system is the potential interruption of the already somewhat limited continuity of care the obstetric model provides. The labor process is greatly facilitated by sharing it with a care provider that a woman knows and trusts. ACOG suggests that obstetricians should inform patients that hospitalists are part of the team that may provide their care. Because of the potentiality of a handoff from private OB to hospitalist (and several nurses in between), clear communication between providers is paramount.

This new model fulfills the ACOG requirement of a physician on the premises during the entire trial of labor for a candidate for vaginal birth after cesarean (VBAC). Because SMH "allows" VBAC and ACOG recommends VBAC for most women with one previous cesarean delivery with a low transverse incision, there is potential for presence of a hospitalist to increase VBAC rates significantly, thereby decreasing the hospital's 42% cesarean section rate.

Listen for updates on the specifics and efficacy of this new model in the coming weeks on Maternally Yours.

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