The obstetrical emergency department: need, rationale, and guide to implementation

Sarah L Bradley; Vasiliki Tatsis; Kristen Wolfe; Trina Pagano; Andrea Tucker; Andrea Bartlett; Tyler Katz

doi:10.1016/j.ajog.2023.12.021

The obstetrical emergency department: need, rationale, and guide to implementation

Am J Obstet Gynecol. 2023 Dec 19:S0002-9378(23)02170-1. doi: 10.1016/j.ajog.2023.12.021. Online ahead of print.

Authors

Sarah L Bradley¹, Vasiliki Tatsis², Kristen Wolfe³, Trina Pagano⁴, Andrea Tucker⁵, Andrea Bartlett⁶, Tyler Katz⁷

Affiliations

¹ Department of Obstetrics and Gynecology, University of Illinois Chicago Rockford, Rockford, IL.
² Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA.
³ Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO.
⁴ Obstetrics and Gynecology Institute, Cleveland Clinic Akron General, Akron, OH (Dr Pagano); Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH (Dr Pagano).
⁵ Department of Obstetrics and Gynecology, University of Kentucky College of Medicine, Lexington, KY.
⁶ Department of Accreditation and Regulatory Affairs, Cleveland Clinic, Cleveland, OH.
⁷ Department of Obstetrics and Gynecology, University Hospitals and Case Western Reserve University School of Medicine, Cleveland, OH. Electronic address: Tyler.Katz@uhhospitals.org.

PMID: 38128865
DOI: 10.1016/j.ajog.2023.12.021

Abstract

The past 2 decades have seen dramatic growth in the number of obstetrics and gynecology hospitalists, and many hospitals have created obstetrical-specific emergency departments. The goals of an obstetrics emergency department are to provide safe and efficient care to the pregnant dyad and postpartum patient, while generating revenue for emergency services provided. In an obstetrics emergency department, all patients must be evaluated in person by a licensed practitioner, whereas historically they may have been evaluated in person by nursing staff or a trainee. We make the argument that formation of an obstetrics emergency department has the potential to improve the safety and quality of patient care. In addition, the financial benefits to institutions are substantial and can subsidize the cost of maintaining obstetrician presence all the time in the hospital. There are various regulatory requirements to become certified, accredited, and licensed as an emergency department. In addition, there are many operational and systems issues that institutions should consider before implementation. We provide a guide for healthcare systems considering creating an obstetrics emergency department.

Keywords: emergency medical services; health resources; hospitalists; obstetrics; patient safety; triage.