The Obstetric Emergency Department: Correcting a Disparity of Care
Pregnant women are managed differently than any other patient in the hospital. If you’re a man with a broken arm, a child with a runny nose, or a senior citizen with chest pains, you’re going to see a physician when you present to the Emergency Department (ED). But if you’re a pregnant woman in the second half of your pregnancy, you’re deemed too high risk for the ED. Women more than 20 weeks pregnant presenting with an obstetric complaint are sent to the Labor and Delivery unit, where a nurse typically evaluates them because there is no physician present. Nurses traditionally manage these patients with the assistance of the on-call provider by phone. This increases risk, as the provider is dependent upon the observations and information provided by the nurse and is unable to directly interact with the patient. Traditional phone triage creates inefficiencies, longer wait times, and unnecessary stress on nurses being asked to practice beyond their clinical scope. This disparity of care increases risk and liability for local providers and hospitals, and it factors largely into patient dissatisfaction. An Innovative Solution In 2006, Ob Hospitalist Group founder Dr. Chris Swain addressed this disparity of care more thoroughly than any existing OB/GYN hospitalist program available at the time. He created an OB/GYN hospitalist model characterized by the creation of an Obstetric Emergency Department (OBED) within a hospital’s Labor and Delivery unit. As a veteran OB/GYN, Dr. Swain knew that triage in Labor and Delivery would be safer and more consistent with the level of care received by patients in the other hospital units if there were a dedicated OBED staffed by OB/GYNs 24 hours a day, 365 days a year. He also recognized that an OBED can function as an extension of the main Emergency Department with relatively minor modifications.
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