St. John's launches OB hospitalist program

Redfern leads a new obstetric hospitalist program in the labor and delivery unit at St. John’s Hospital, launched in March.

Hospitalists are hospital-based physicians who take care of patients whose primary care physicians are not available either temporarily or during the length of a patient’s hospital stay. An OB hospitalist may be needed when a patient’s regular OB/Gyn is out of town or if an emergency Caesarian-section delivery is necessary.

“If we can take one of these situations and deal with it internally, that frees (OB physicians) to be more efficient in other areas,” said Redfern, medical director of the OB hospitalist program.

St. John’s internal medicine hospitalist program started in 1997 and has since grown to include pediatric hospitalists.

Redfern rejoined St. John’s to head up the OB hospitalist program. He split with the hospital system in 2000 and subsequently filed a lawsuit with his partners at The Woman’s Clinic against the hospital in 2001. The lawsuit was eventually dismissed on summary judgment. Redfern’s practice has been limited to gynecology since 2004.

“When managed care came about, it wasn’t just about us, but all physicians had issues with it,” Redfern said. “The lawsuit was a long time ago, and we’ve actually buried the hatchet.”

Redfern says there have been positive changes at St. John’s since then, and he made it known long ago that if the hospital decided to pursue an OB hospitalist program, he would be interested.

Redfern, the program’s sole OB hospitalist, said the idea for the program came after OB physicians as a group looked at safety and efficiency issues.

Articles on the OB hospitalist or “laborist” movement had been published, and the physicians were intrigued, he said.

From there, Redfern and Dr. Meera Scarrow, St. John’s OB/GYN section chair, worked on creating the program for about a year before its implementation.

“The primary purpose is to ratchet up the response time to really sick moms and babies,” Scarrow said. “The OBs, including me, plan to keep doing their own deliveries, but it’s nice to know someone is there.”

Scarrow added that Redfern doesn’t intervene unless he’s asked or an emergency occurs. For instance, if the patient’s OB has other appointments scheduled in the office, that doctor may ask Redfern to monitor a patient in labor. Redfern also can take care of patients who haven’t seen an OB regularly, care for transfers from smaller facilities and assist in Caesarian deliveries.

“I’ve heard from several of my partners that they were glad he was there to help,” Scarrow said. “C-sections, though routine, can get complicated quickly.”

Redfern, who has delivered about 5,000 babies in his career, currently works four or five 12-hour shifts a week, and serving as a hospitalist allows him to actually be off work when he’s not on shift – a luxury that regular obstetricians aren’t likely to have.

Both Redfern and Scarrow say the average retirement age for OBs is between 40 and 45 because of the demanding schedules.

“OBs are responsible for their offices, labor and delivery, the operating room, the emergency room and their own families. It’s difficult for OBs to be in all places simultaneously,” Redfern said. “The relationship between a pregnant woman and her doctor of nine months is not one that we want to try and be in the middle of.”

Redfern said that initially, labor and delivery nurses were a bit skeptical of the OB hospitalist program, and Alisha Woodmansee, a labor and delivery nurse for 15 years, noted that for the first month, they weren’t sure how to utilize Redfern. But now, she said, they recognize that it’s good to have a physician available when there’s an unusual fetal heart rate or other concerns to discuss.

“It takes the responsibility and pressure off the nurse when you have a doctor on the unit at all times,” Woodmansee said.

Woodmansee says she could name several instances where patients have benefited from Redfern’s presence.

“If a patient is bleeding and her doctor has already gone back to the office, Dr. Redfern can assess immediately. He’s also started C-sections while the other doctor was on the way. Before, we would’ve had to wait for a doctor on call to come from the office or home,” she added.

Another OB hospitalist will join St. John’s in August, but in the meantime, other obstetricians are taking shifts to serve as hospitalists.

To have 24-hour coverage, 365 days of the year, Redfern says the goal is to have one part-time and three full-time OB hospitalists in the program.

At CoxHealth, where an internal medicine and pediatric hospitalist program has been in place since 2002, officials say there aren’t currently any plans to add OB hospitalists. “It might be something for us to think about,” said Tresa Seibert, clinic manager of Springfield Inpatient Physicians at CoxHealth. [[In-content Ad]]