Topic # 2: Gyn care and admission

We also cover no doc GYN patients that come into the ED.  We have been asked to also see private GYN patients if the private doc is busy or maybe just at home. Should we be hard nosed about this and say no to private GYN patients or should we comply.  If we see the private GYN patient the private docs know that we will manage the case including surgery.  So it is service and maybe better care and income to the program since these patients are usually insured, but it does take us away from the OB floor.

-Terry Pheifer M.D.

Evergreen Healthcare

12040 NE 128th Street

Kirkland, WA  98034

Interesting question.  The problem with accepting the care of these patients is they may take the hospitalist away from the labor and delivery suite for prolonged periods of time.  I would generally be against this but perhaps they could be handled based on the availability of the hospitalist and complexity of the case.

-Tom Garite, M.D.

If the hospitalist is available, s/he admits and manages the GYN ED patient. Builds the necessary relationships and improves care.  If the hospitalist is genuinely unavailable, ED management defaults to the old community call system.

-Duncan Neilson, MD

Legacy Health System, Portland, Oregon

Hard to say- some people dump the bad cases on the hospitalists, which can be challenging and frustrating, but in general it seems like it usually worked out. We have residents where I was so sometimes it would be an issue in that the gyn attending would not discuss the case directly with the ob/gyn hospitalist and things would fall through the cracks.

-Alison Madden

We are ob-gyn hospitalists, so we do all the GYN through the ED. The hospitals we work in still maintain a ob-gyn call list. The purpose of this is multifocal: We refer unassigned ob and gyn patients we care for to their office for a post-partum/post-op check. The person on call is available to us for back up if we need them for things such as c/s assists, gyn surgery assists, or extreme busyness. It is very rare we call on them, but it does happen. Thus far, this has been received very well. We often schedule gyn surgery in the a.m. at shift change and help one another, rather than calling on the staff physicians. In one of our programs we are currently tracking the ³burden of back-up for the staff physicians and we have a proposal on the table to provide our own back up which would then reduce the on-call list being maintained to serve as a post-op/post-partum follow-up only. Our gyn services are very busy and fairly profitable.

-Wayne L. Farley, Jr., DO, FACOG

Regional Medical Director-Questcare Obstetrics

OB-GYN Hospitalists

Dallas, Texas  75251