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STARTING A SUCCESSFUL OB/GYN HOSPITALIST PROGRAM
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The reasons that a hospital or healthcare system starts OB/GYN hospitalist programs generally fall into eight categories:
It has experienced a series of bad outcomes, with subsequent high malpractice costs and payment amounts.
There is a shortage of private-practice OB/GYNs because of retirement, loss of privileges, or an increased number of patients creating demand. The small number of OB/GYN practitioners causes the institution stress because nobody wants to take calls or respond to consultation requests from family doctors and midwives.
There is high turnover among the nurses because a lack of timely response from the overworked staff of OB/GYNs results in the nurses performing deliveries unattended by physicians, caring for high-risk patients with no physician in the hospital, and dealing with dissatisfied patients waiting for evaluation in OB triage.
The administration is dissatisfied with paying for call coverage but receiving no financial return, as well as unhappy OB/GYNs forced to be on call. The money spent by hospital administration does not result in improved quality and safety.
The hospital or healthcare system is losing obstetrical patient volume.
The neonatal intensive care unit (NICU) has excess beds, but there is a lack of high-risk maternal transports with premature infants.
Academic programs lack high-quality experienced OB/GYNs for teaching residents, especially in Family Practice–only settings.
Local Maternal Fetal Medicine (MFM) physicians need support.
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The drivers for change generally include one champion who recognizes the problem or problems and realizes that an OB/GYN hospitalist program is the solution. If it is the Chief Executive Officer (CEO), he or she appoints a committee to study the problem and solution. If it is a private OB/GYN, the director of maternal-fetal health, or risk management, they convince the CEO first. The committee will then begin to formulate a plan using local resources, engage a consultant, or issue a request for proposal (RFP) to the various national staffing companies. (See Table 2-2 for a list of staffing companies and their contact information.)
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The timeline from initial consideration to opening a full-time OB/GYN hospitalist program can range from 3 to 6 months to as long as 12 to 18 months, depending on the following:
Whether staffing is done with local doctors or out-of-state physicians are recruited
The geographical location and desirability of living conditions
The reputation of the hospital, morale of the nurses, and availability of support from anesthesia, pediatrics, neonatology, lab, and blood banking
The pay and benefits offered
The state licensing requirements and the hospital credentialing timeline