How a combined OB-ED improves care at St. Bernards Healthcare

October 8, 2019 |  Nursing, Productivity, Care Coordination

Smiling doctor showing ultrasound scan to the couple in medical office

Expectant mothers present a unique set of challenges for the providers who care for them; aside from their own health, clinicians are also tracking and responding to the needs of their unborn babies.

At St. Bernards Healthcare, we’ve developed a combined OB-ED program that ensures quick, efficient care — and results in higher satisfaction for patients and providers.

Before we look at how the St. Bernards system works in practice, let’s take a moment to review the thinking that went into it.

What we set out to do

Located in northeastern Arkansas, St. Bernards is one of the largest healthcare providers in the state, and recently expanded into southern Missouri with our new clinic in Kennett, MO.

According to the Centers for Disease Control and Prevention (CDC), about 700 women die from complications related to pregnancy every year in the United States, with 31 percent of those deaths occurring during the pregnancy.

The CDC also estimates that 60 percent of those deaths are preventable with timely, effective medical support. At St. Bernards, we see that as an opportunity to elevate the standard for women’s care.

Launched in 2016, our OB-ED’s mission is to have every expectant mother seen by a physician within 30 minutes of arrival, and released within two hours if they are not admitted.

It’s an ambitious goal that required us to realign our workflows and staffing strategies, but we’ve achieved impressive results thanks to the coordination among our clinical and executive teams.

And with a percentage of our patients being Medicaid recipients and living in rural areas, we also recognize the challenges that they often face in just getting to the hospital when they need care — and we’ve set up our OB-ED to make sure they get the best care as quickly as possible.

How the OB-ED works

With all of the anxiety and stress that an expectant mother can experience when visiting an ED, the most important thing a hospital can do is establish a sense of calmness and purpose, showing that the staff knows what they’re doing and can carry out their work efficiently and compassionately.

The main way we’ve addressed this at St. Bernards is in simplifying the intake process to minimize the time that a patient is waiting to be seen. When an expectant mother comes into our OB-ED at 20 or more weeks pregnant, the intake staff provides her with a paper registration form. The nurse creates a pre-account for the patient's short registration.

Once the form is completed it is sent to main registration, where a full registration is completed on the patient. The nursing staff triages the patient in the OB-ED, then a physician examines the patient and writes up orders.

From there, the patient is monitored as the doctor’s orders are carried out, leading to the decision to admit or discharge the patient.

And because of the coordination among the clinical staff, and the location of the OB-ED near the main OB entrance, we’re able to accomplish all that patient interaction within two hours.

Results from the OB-ED

Since St. Bernards implemented the OB-ED model, we’ve seen an increase in patient and clinician satisfaction, while wait times and returns to the ED have been reduced.

We’ve also seen a general improvement in continuity of care, fewer unattended deliveries, and an overall better experience for hospital staff and local physicians.

And let’s face it: Rural hospitals are under intense pressure to maintain their bottom line — and from what we’ve seen so far, the benefit of the OB-ED also extends to finances.

We’re able to bill for both ED and OB services, and for additional services like NICU and transportation, depending on the patient’s needs. 

That ability to bill separately — which requires formally releasing patients from the ED to the OB — is very important, because in the OB most reimbursement is by the global fee paid for antepartum care.

For St. Bernards, the OB-ED was a significant change in how we once delivered care to expectant mothers — in registration, clinical workflow, billing, and staffing.

Considering the positive impact it’s had on our staff and patients, though, it’s definitely been worth the effort.

See how Expanse improves care for mothers and their babies.

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Written by Jeffrey Battles, RN, BSN, St. Bernards Healthcare

An RN at St. Bernards Healthcare in Missouri, Jeff has 15+ years of nursing experience and 8+ years of MEDITECH experience focused on the implementation, optimization and support of MEDITECH EHR platforms. Five years was spent working with a consulting firm implementing and optimizing MEDITECH for hospitals across the country. Jeff’s clinical background includes providing patient care in medical surgical, emergency medicine, and management of a 40 bed orthopedic department. He uses this experience to help incorporate into the planning, development, implementation and support of healthcare information systems. He has trained and worked with nurses and other clinicians in the use of MEDITECH software and understands the current processes of nurses, the concern for patient safety, the importance of integrating quality, evidenced-based practice and regulatory initiatives into the development of the MEDITECH software.