Collaborative Care Saves Lives at St. David’s Women’s Center

By Brian Monks, MD on September 12th, 2013

In 2005, Dr. Chris Swain, not satisfied that OB patients were the only patients presenting to a hospital who were not routinely seen by a physician, decided to create a comprehensive OB/GYN hospitalist model. Dr. Swain believed that physician triage in Labor and Delivery (L&D) would be safer and more consistent with the level of care received by patients in the other hospital units. He was also astute enough to recognize that many L&D triage units could function as emergency rooms with only minor modifications if a physician was present on a 24/7 basis to evaluate these patients.

This novel idea proved to be a huge breakthrough for the OB/GYN hospitalist movement and the physicians proved to be capable of elevating the quality of care for OB patients. One area of OB hospitalist utilization that is showing great promise as a result of this more comprehensive hospitalist model is the formation or expansion of a high risk OB/Maternal-Fetal Transport (MFT) service. Many hospitals have under-utilized Neonatal Intensive Care Units (NICUs) and a limited ability to take care of high-risk OB patients because they are unable to provide adequate monitoring and rapid intervention without a qualified physician in-house at all times. These facilities often have limited access to or support of sub-specialists such as neonatologists (NEOs) and Maternal Fetal Medicine physicians (MFMs). Furthermore, community providers are commonly not interested in managing patients of this type because they are very time consuming and intrusive to the daily operation of a private practice. These patients are also at an increased risk for poor outcomes and can be associated with an increased risk of liability exposure for their providers. Hospitals are now exploring utilizing OB/GYN hospitalists, in partnership with MFMs and NEOs, to overcome these obstacles. OB/GYN hospitalists are proving themselves to be vital to the successful implementation and daily functioning of MFT services. 

Please click the video below for a brief overview of the factors that led up to St. David's implementing an Ob Hospitalist Group program.
 

The presence of OB/GYN hospitalists can be very valuable to facilities trying to recruit MFMs. Many MFMs do not want to function as the primary care providers while patients are hospitalized. High risk patients require a much greater presence on L&D and limit availability for out-patient consultations and ultrasound exams. Utilizing OB/GYN hospitalists as the primary care providers for these patients has enabled them to receive the direct patient care they need while allowing the MFMs to function as consultants. This MFT service model allows both the MFMs and OB/GYN hospitalists to share in the management of these patients and be more productive. It also allows patients of high acuity to receive exemplary care in a non-academic setting. Successful marketing and outreach efforts are facilitated by such an arrangement as well because the referring physicians become familiar with a core group of physicians who collectively provide excellent continuity of care to patients. The MFT service team members are not viewed as competitors who might funnel patients into their own practices because they are hospital-based and do not have private offices. These members also communicate with the referring physicians about their patients on a regular basis in order to provide status reports and facilitate smooth transitions back into the community providers’ practices, when appropriate. Once successfully implemented, the MFT service will yield an increased number of neonates being born. Most of these will be born prematurely and require specialized care after birth. This influx of neonates will result in an increased NICU census and, quite possibly, the need for NICU expansion in order to accommodate for this growth in volume.

In 2012, the Society of OB/GYN Hospitalists (SOGH) polled its membership as to whether they collaborated with MFMs on a regular basis as part of a high-risk OB patient referral. Over 50% of the respondents indicated they did. The vast majority of respondents were working in private, non-academic, community hospitals. Clearly, the naturally symbiotic relationship between OB/GYN hospitalists and MFMs is being acknowledged and the benefits of successful collaboration between these groups of physicians are being realized by many hospitals. St. David’s Women’s Center of Texas in Austin, TX, (part of the North Austin Medical Center) is a prime example of how successful this type of collaborative care can be for hospitals.

St. David’s Women’s Center of Texas in Austin started its OB/GYN hospitalist program in partnership with Ob Hospitalist Group in August of 2008. The hospital is a community-based, private facility and at that time it had no formal MFT service and MFM services were provided by local MFMs on an “as needed” basis. Attempts at obtaining on-site, hospital-based MFM services were unsuccessful. Its level III NICU had only 19 beds. Within 6 months after implementation of the OBHG hospitalist program, the first MFM was successfully recruited and a second MFM was hired within the following year. These sub-specialists were attracted to this facility because they were interested in developing a MFT service and utilizing OBHG hospitalists to provide the primary care to these patients and allowing the MFMs to serve as consultants.

Dr. Kimberly DeStefano, the chief perinatologist, worked diligently along with St. David’s administration and the OBHG hospitalist team to design the MFT service and present it to the providers at hospitals throughout the central Texas region.

  • By the summer of 2010, the MFT service was launched. 
  • By the end of that year, 34 transports were accepted by the team.
  • In 2011, this number rose to 108 with 58 (54%) of the patients being delivered by the team and 48 (83%) of the babies admitted to the NICU.
  • In 2012, the number of transports again rose to 171 for the year and the MFM team grew to three.
  • Ninety-seven (57%) of these patients were delivered by the team and 80 (82%) of the babies needed to be admitted to the NICU.

This year, the volume has remained essentially constant and the MFM team now has four members with a fifth MFM scheduled to join the team in the fall. The MFMs are now also working in a second, satellite clinic and performing in-patient consultations at a referring facility. In less than three years, the MFT service at NAMC went from being non-existent to the largest one in the greater Austin area and continued growth of this valuable asset is expected.

Dr. DeStefano recently commented on the success of this program by saying,  “The OBHG hospitalists were integral in my ability to build a robust inpatient and maternal transport service line. Our collaboration allowed for exponential growth in a short period of time and widespread acceptance."

Dr. John Thoppil, an OB/GYN who has referred several patients to this MFT team, recently stated, “I have been very impressed with the OBHG Hospitalist/MFM maternal-fetal transport team at St. David’s. I have utilized the service for my highest risk patients that have needed a higher echelon of care. It is comforting to know that a physician is in-house at all times for any possible emergency.”

These sentiments are shared by other referring OBs. According to Maggie LaJaunie, MBA, BSN, RNC-NIC, Director of Maternal/Neonatal Outreach for the Central and Western Divisions of HCA/St. David’s Healthcare, “Community hospitals need a safe and quick way to get their patients to a facility with a higher level of care, but it is important to them not to lose touch with their patients. The collaboration between our OBHG hospitalists and MFM group provide this service. We are just a phone call away for a consult, transport, or follow-up. Most important to our customers is that our physicians are always available, they communicate with the sending physicians keeping them informed of their patient’s progress. The level of care we provide is higher than anything they’ve experienced. We save moms and babies’ lives that otherwise would have been lost. We make it easy for them to do what is best for their patients.”

The growth of the MFT service was not the only type of growth experienced by the St. David’s Women’s Center of Texas, however. The OBHG hospitalists and MFMs are valuable resources for the staff OBs and nurses by providing patient care support and rapid responses to emergencies. This team of providers helped to make patient care safer and the lives of staff OBs and nurses less stressful. These benefits greatly enhanced the recruitment efforts of NAMC with many more OBs and nurses joining the staff. In fact, the number of deliveries rose from about 3400 in 2008 to over 5800 in 2012.This very impressive growth necessitated an expansion. The once under-utilized NICU went from 19 to 39 official beds and a second expansion to 61 beds is underway. An antepartum unit was also built and is being expanded since many patients remain in L&D due to a lack of antepartum unit beds. L&D is also going to be expanded within the next year and at least two critical care OB rooms will be added to this unit for higher acuity patients.

The success of NAMC’s growth strategy was recently summed up by its CEO, Allen Harrison, who said, “The OBHG hospitalist team enabled us to successfully recruit the MFMs. Then, in collaboration with each other, a very successful MFT service was developed and the overall quality of patient care was elevated on the obstetrical service. The expansion in women’s services at the St. David’s Women’s Center of Texas has proven to be one of the major components of NAMC’s overall growth strategy and it has contributed to this facility’s transformation into a leading provider of healthcare in central Texas as well as within the entire HCA network of hospitals.”

The overwhelming support of the OBHG hospitalist team and recognition of its contribution to the MFT service was recently confirmed by Dr. Sina Haeri, a member of the North Austin Maternal-Fetal Medicine Group, who stated, “With respect to transports and patients on antepartum/L&D, they make the process flow seamlessly. With their help, I'm able to direct my attention to the high risk problems that require my expertise and efficiently cover a large volume in a relatively reasonable time. In emergent cases they are present to help without hesitation. They are capable, knowledgeable, and yet willing to learn and teach. I can truly tell you that I have yet to experience anything negative. I love the OBHG team and consider it one of the major benefits of being an MFM at NAMC.”

This sentiment was echoed by Dr. Kenneth Mitchell, the CMO of St. David’s North Austin Medical Center, when he recently stated “The OBHG hospitalist program at our hospital has been a huge success and has contributed to the highly successful opening of St. David’s Women’s Center of Texas and the development of a rapidly growing Maternal-Fetal Medicine program dedicated to our hospital.”

Dr. Kody Kunda sums up the peace of mind he has with regard to transferring his high risk patients to St. David’s, “I am able to transfer anyone I do not feel comfortable taking care of. I was never told no to a transport. Once the patient gets to St David's north, there is always a hospitalist waiting for them to provide the best obstetrical care. There are many patients who had an unexpected good outcome. I had a patient who lost multiple pregnancies at 23 weeks gestation. By keeping her on in hospital bed rest, she made it to 28 weeks. I had a patient with twins that delivered one at 17 weeks. She was expected to lose the second one. St. David's North accepted her transfer as soon as requested. She later had a cerclage placed. With in-hospital bed-rest, she is still pregnant at 30 weeks gestation.The communication with St. David's North providers has been excellent. I always get feedback. Once the patient was discharged, still pregnant or delivered, they always came back to me. These patients had a wonderful experience. They were impressed with the quality of care at St. David's North." 

In conclusion, it is safe to say OB/GYN hospitalists, in collaboration with MFMs (and NEOs), can clearly implement and expand MFT services very effectively. Undoubtedly, there will be more success stories like that of St. David’s Women’s Center of Texas as the OB/GYN hospitalist movement continues to grow and more hospitals realize the value of the collaborative care model between OB/GYN hospitalists and MFMs/NEOs.

We invite you to discover more about OBHG and the advantages that our customized programs deliver to our partner hospitals, physicians and patients.  Contact an OBHG representative today at Programs@obhg.com or  800.967.2289

Written and published by OBHG Media. Copyright © 2013.
 

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