“The team was worried about a recurrent shoulder dystocia. This patient had a previous shoulder dystocia which lasted a couple of minutes. This is a situation where the minutes that pass before delivery is a critical time when the unborn baby is without oxygen. We had a pre-delivery briefing so everyone knew their role. Just after she delivered her baby without incident, I was called urgently into another room where they had encountered a shoulder dystocia and were still trying to get the baby delivered. This patient had no risk factors for shoulder dystocia and a normal labor until that moment. I was able to run into the other room and help dislodge the shoulder and successfully deliver the baby. Preparation and response time is critical. This scenario illustrates how you can do your best to predict potential emergencies, but you just never know when and to whom it will happen.” – Dr. Brendan Carroll.
Obstetrical emergencies such as shoulder dystocia, postpartum hemorrhaging, hypertension, and cord prolapse are not common situations during pregnancy; however, when they do occur it can be a nerve-racking experience for the practitioners, mother and baby. How obstetrical emergencies are handled can be the difference between a positive and a negative outcome. When the unforeseeable strikes, the OBGYN hospitalist model provides better patient safety because of rapid response time, experience, and effective communication.
When it comes to emergencies TIME is of the essence. In labor, events are often unpredictable and change fast. Take a prolapsed cord for instance. The mother’s water breaks, and the cord slides outside of the mother’s body in front of the baby’s head. The course of action is an immediate C-Section before blood flow and oxygen is cut off to the baby. In this case there is 5 to 15 minutes to save the infant’s life. The time it takes to contact the physician, who may be at home or at the office, plus the time it takes for them arrive at the hospital could be too long. In a hospitalist model an OBGYN specialist is always available on a moment’s notice. These highly trained obstetricians are ready to take action while the patient’s physician is en route or to take the lead during an emergency.
As they say, practice makes perfect, and it’s no different in health care. An OBGYN is specialized in women’s health and has extensive EXPERIENCE in maternal health. Although an obstetrician is specialized and well trained, the number of experiences they have compared to an OBGYN hospitalist can make a difference.
“When I owned my own practice for 16 years I would experience an obstetrical emergency no more than 2 or maybe 3 times a year. As an Obstetric Hospitalist, I deal with an emergency at least every couple of weeks.” -Dr. Brendan Carroll.
In a supporting role for midwives, family physicians and even other obstetricians, an OBGYN Hospitalist is exposed to many emergencies. These hospitalists have the opportunity to gain experience and hone their skills. It is not uncommon to have experienced obstetricians seek assistance from OBGYN hospitalists for a quicker and more effective results. Hospitalists frequently manage obstetrical emergencies as well as practice them with simulation training. This preparation and experience leads to improved outcomes for the team, mothers and babies.
Obstetrical emergencies usually occur by surprise. While quick action and specialized skills are key, various channels of EFFECTIVE COMMUNICATION during these stressful situations are equally important. If a hospital is inexperienced in these emergencies, chaos can ensue. Uncertainty of roles, delay in action and indecisiveness may quickly turn an urgent situation into a critical one. Effective communication includes following emergency protocols and guidelines. OBGYN hospitalists work with the hospital in creating a “playbook” of protocols to ensure everyone knows who and what needs to be done given a specific event.
These protocols are especially helpful for emergent situations and for problems that are not encountered frequently. Utilizing these protocols such as postpartum hemorrhage and hypertensive emergency helps avoid an unfortunately common problem of delay and denial. The thought process of waiting to intervene (delay) because you think or hope that the situation improves (denial) may lead to a much more complicated situation, placing the patient at serious risk. Many hospitals are realizing the value of standardizing the way teams communicate with each other, allowing anyone in the team to speak up if they are concerned or have valuable information to offer. Clear communication, protocols and a trained team increase the safety and the quality of care for mothers and their babies.
When you are faced with obstetrical emergencies how does your team respond and what are the outcomes? Do you wish you had a highly trained OBGYN immediately available to intervene and make a difference for the mother and her baby? What is this service worth to the peace of mind of the night nurses, the OBGYNs at home, the mother and her baby? If you are interested in improving the quality and safety of OBGYN patient care and would like to start a new hospitalist program, help an existing program, or transform outpatient triage evaluation of women to an obstetrical emergency department, we are here to help. Please contact us, we would love to hear from you!
– Dr. Rob Olson
Dr. Olson is the founder and principal of National OBGYN Hospitalist Consulting Group. Dr. Olson is a leading OBGYN Hospitalist and Entrepreneur who is passionate about continual improvements in safety and patient care, Dr. Olson is the founder and former president of the Society of OB/GYN Hospitalists, currently the largest organization providing support and opportunities for OBGYN Hospitalists in the United States.