The OB-ED model fundamentally changes how hospitals care for expectant mothers in a way that improves patient satisfaction, enhances patient safety and quality of care, and increases hospital revenue.
One of the most recent and innovative women’s healthcare service offerings is the obstetrical emergency department, or OB-ED. The OB-ED redefines the standard of women’s care in the hospital setting, promoting patient safety and enhancing satisfaction, improving quality, and reinforcing community provider relationships—all while embracing an entrepreneurial approach to strengthening hospital finances.
With an OB-ED, every qualifying patient who presents at the hospital with an obstetrical complaint is seen in the OB-ED setting. In accordance with the Emergency Medical Treatment and Active Labor Act (EMTALA), each patient receives a medical screening exam by a qualified health professional in conjunction with the nursing assessment she would have received under the obstetrical triage protocol. However, unlike the triage environment, every patient in the OB-ED is also evaluated by a physician prior to discharge.
The positive impacts of implementing this model of care are numerous and significant, such as:
- Enhanced patient safety and quality care, including fewer complications and return visits
- Improved patient satisfaction
- Increased nursing staff satisfaction and retention
- Improved hospital finance
Making it Work
Because an OB-ED requires around-the-clock physician coverage, physician staffing is the critical component to establish an OB-ED. Although some large academic medical centers fill this need with resident coverage, the most successful model for providing OB-ED physician coverage is through an OB hospitalist program.
With an OB hospitalist service, the hospital gets 24/7 staffing from an OB physician whose primary responsibility is the OB-ED but who also provides coverage for unassigned OB patients and as needed for call coverage in the main emergency department.
An OB hospitalist partner should know how to establish a successful OB-ED that will meet Centers for Medicare and Medicaid Services regulations as well as the standards of the department of health in the state where the hospital is located. The hospitalist will also be able to develop an implementation plan as well as an ongoing operations and business development plan for the OB-ED.
Depending on payer mix, in hospitals with approximately 1,500 deliveries per year, the facility revenue generated by the OB-ED can offset the cost of the OB hospitalist program. For hospitals with a delivery volume greater than 1,500, revenue from the OB-ED may cover more than the cost of the OB hospitalist program and thereby generate a profit. An added benefit is that satisfied patients who leave the OB-ED are more likely to return to the hospital again when they or their family need hospital or emergency care, providing repeat patient revenue.
Overcoming the Hurdles
Unfortunately, the implementation of an OB-ED and OB hospitalist program may not be met with fanfare at every hospital. For some facilities, bringing in an OB hospitalist to open an OB-ED can raise alarm among community physicians who fear that they will be edged out of the hospital or have their patients “stolen” by the hospitalists. These providers may propose offering their own “laborist” or doctor-on-deck type of program, or they may threaten to take their patients elsewhere if the hospital moves forward with an outside hospitalist partner.
When facing a proposal from community OB/GYN physicians to provide OB-ED coverage, hospital executives must weigh several factors.
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