Labor and delivery is a fast-paced environment where normal labor can turn into an emergency in seconds. We always stress the importance of having a dedicated, fully staffed OBGYN hospitalist. 24/7 coverage and specialized skills, especially in complicated or less common, but high-risk situations, improves patient safety and care. An important part of this coverage is to know your limit.
Imagine you’re on a hospitalist shift caring for a few patients and you are the only physician in the hospital. One of your patients has a delayed postpartum hemorrhage. You weren’t able to attend to her right away since you were in the operating room, so she has lost more blood than normal, and now requires a blood transfusion. Had a backup been called earlier the blood transfusion on the second patient could have been avoided.
Anticipate the need
It can be difficult to gauge when a backup should be called in. Understanding when it’s unsafe for hospitalists and their patients is a critical skill, and physicians must exercise their clinical judgement. Assessing the volume, mix of patients (primpara or multipara), their risk factors (health conditions like high blood pressure or diabetes for example), and your own bandwidth (mentally and physically) are determining factors in knowing when extra help is needed.
Audit your numbers. Often times hospitals will review averages, like how many deliveries occurred in a day; however, this broad look can miss important details. By tracking the time deliveries happen, you can discern trends for better scheduling. Understand where the volume occurs, and let the details guide your decisions. Generally, if you are calling a backup more than two or more times a week we’d advise instituting a scheduled 2 people during high volume times. Some high volume programs have a “rounder” who sees all of the postpartum patients, leaving the labor and antepartum patients for the hospitalist. Depending on the hospital’s resources, culture and state regulations, it could be another physician or a midwife.
Even when you’ve forecasted the need, and scheduled accordingly, we recommend having a safety valve, a physician you can call for backup. Most physicians know someone they can call for help, but ideally a hospital will have a formal backup system in place to guarantee assigned support when the need arises.
How to ask for a backup system
If the hospital where you work doesn’t have a backup system speak up. This safety net requires financial commitment, and the costs need to be justified. To gain acceptance there are a few actions hospitalists can do to improve their program’s safety.
- Know your audience. The board of directors will need to review your request, and they are not likely to be physicians or obstetricians. Share stories that make it easy for your audience to understand the current situation and risks using layman words, not medical terms.
“Mrs Smith had premature separation of her placenta. Not only was her baby in danger, but she was bleeding as well. I was doing a c-section with Mrs. Young. I was able to call in Dr. Jones who came in and saved Mrs. Smith’s baby’s life.”
- Let the numbers speak for themselves. Keep track of your statistics. If you can show you delivered 8 patients in a day people will know that is too busy. And as mentioned, the more detailed your numbers are the better. As any hospitalist knows, you may have an incredibly busy shift and not deliver a single baby.
- Near misses are just as important. Catastrophic results like the death of a baby are devastating. They highlight the problem clearly; however, near misses highlight events that could have turned into a bad outcome. You’ll likely have more near miss examples to reference than bad results.
- Be the squeaky wheel. Formally send your stories and statistics in writing to the Department Head, Medical Director, or Risk Management. “This could be a safer program if we had a backup.”
Obstetrics is a dynamic field. Even with years of experience, you can never predict every scenario, but you need to be prepared for it. For those unexpected situations, whether it is an emergency or a surge in volume, all hospitals should have a backup system in place. By sharing the need for a formal backup system through stories and data, you can make it an easy and financially justifiable decision to improve the safety of your patients. We have over 25 years of experience working with hospitals striving to improve the quality of care for their patients. Establishing an OBGYN backup system is part of the solution. If you have questions or want to learn more about how hospitalist models improve patient and staff satisfaction please contact us. We’re looking forward to hearing from you!