mayoclinic.org
Jan. 09, 2024
A multicenter study led by a Mayo Clinic physician has found that among hospitals providing 24/7 OB-GYN coverage, institutions staffing with OB-GYN hospitalists have lower rates of severe maternal morbidity (SMM). The Journal of Patient Safety published this study's results in a 2023 issue.
"Our findings show that it can make a difference if there is a hospitalist present who can attend to emergencies immediately and who is up to date on OB emergency protocols," says Vanessa E. Torbenson, M.D., an OB-GYN hospitalist at Mayo Clinic in Minnesota and lead author of the paper.
OB-GYN hospitalists can intervene in the care of patients hospitalized for delivery to prevent or turn around an unexpected outcome with long-term consequences. Their presence also benefits other medical professionals at the facility. For example, if an OB-GYN hospitalist is on duty, this can allow other OBs to be home for dinner. This role also enables other OBs to be present longer with other patients in the office even if one of their patients is in the hospital, says Dr. Torbenson. She also mentions that due to such benefits, having a hospitalist on staff is good for recruiting other OBs to the hospital.
The observational study published in the Journal of Patient Safety compared data presented in a 2019 USA Today article titled "Deadly deliveries: Childbirth complication rates at maternity hospitals" with data gathered from phone and email surveys of staffs at the hospitals mentioned in the article. The survey responses indicated whether the facility had 24/7 OB coverage and categories of staff present, comparing them with the SMM reported by the USA Today article.
Dr. Torbenson's research team contacted 810 hospitals. The response rate was 75.8%, with 614 labor and delivery units participating. The researchers found that 24/7 coverage existed in 57% of surveyed hospitals. Among these hospitals, an OB-GYN hospitalist primarily covered OB inpatient care 46% of the time. A nonhospitalist OB-GYN provided care 54% of the time for the hospitals surveyed.
Notably, increases in delivery volumes and neonatal care levels accompanied 24/7 care and SMM. However, for hospitals that mostly provided coverage through OB-GYN hospitalists, SMM was lower compared with that at facilities that mostly used nonhospitalist OB-GYNs: 1.7 versus 2.0 for all mothers and 1.9 versus 2.3 for low-income mothers.
The researchers undertook this study because data specifically related to OB-GYN hospitalists has been limited, though numerous studies have demonstrated the value of medical hospitalists in general, according to Dr. Torbenson. Staffing with OB-GYN hospitalists is increasing nationwide, and their presence has been associated with lower rates of preterm delivery and induction, according to a 2016 publication by Srinivas and colleagues in the American Journal of Obstetrics & Gynecology. Publications such as a paper in a 2015 issue of Obstetrics and Gynecology Clinics also found lower cesarean rates with the presence of an OB-GYN hospitalist.
From the findings published in the Journal of Patient Safety, Dr. Torbenson has the following recommendations for U.S. hospitals providing OB care:
"We know that SMM increases with delivery volume; thus it becomes invaluable to a hospital with large volumes to have a hospitalist," says Dr. Torbenson.
She explains that it is important for each hospital to analyze the risk-benefit ratio for the presence of an OB-GYN hospitalist at its facility.
Torbenson VE, et al. Use of obstetric and gynecologic hospitalists is associated with decreased severe maternal morbidity in the United States. Journal of Patient Safety. 2023;19:202.
Deadly deliveries: Childbirth complication rates at maternity hospitals https://www.usatoday.com/maternal-mortality-harm-hospital-database. USA Today. 2019.
Srinivas SK, et al. Evaluating the impact of the laborist model of obstetric care on maternal and neonatal outcomes. American Journal of Obstetrics and Gynecology. 2016;215:770.e1.
Iriye BK. Impact of obstetrician/gynecologist hospitalists on quality of obstetric care (cesarean delivery rates, trial of labor after cesarean/vaginal birth after cesarean rates, and neonatal adverse events. Obstetrics and Gynecology Clinics, 2015;42:477.