In obstetrics, the gap between recognizing an emergency and responding is measured in minutes and outcomes. Across the United States, clinicians at Ob Hospitalist Group (OBHG) are closing the gap by pairing 24/7 in-house presence with disciplined systems, including:
- Multidisciplinary rounds
- Risk recognition tools
- Improved communication
- Simulations
- Ready-made kits
- Debriefing
With practice, the correct response becomes automatic. In a webinar focused on evidence-based responses to emergencies, Venus Nabors, MD, Senior Market Medical Director, shared one of many examples where her team’s skilled and constant presence ensured an emergency delivery had a happy ending.
A 28-year-old mother arrived by EMS, crowning as she was wheeled into labor and delivery. Her private physician was 37 minutes away.
Dr. Nabors was already in-house and reached the room in seconds to deliver the baby safely, avoiding a nurse-assisted delivery. But the real emergency was still ahead. When the placenta failed to deliver after 30 minutes, the team moved her to the OR for a retained placenta. The patient began to hemorrhage, and then years of simulation and protocols kicked in.
Dr. Nabors manually delivered the placenta, administered uterotonics and guided the team through the postpartum hemorrhage protocol. By the time the private physician arrived, the team had ensured the uterus contracted, bleeding subsided and mother and baby were both safe.
“That hemorrhage absolutely would have happened before he could have reached the hospital,” says Dr. Nabors.
For this family, an in-house OB hospitalist wasn’t just a convenience. It meant the difference between a potential catastrophe and a routine emergency managed well.
“When an emergency pops up, everyone already knows who we are and what we do. That situational awareness changes everything,” says Dr. Nabors.
Watch the full webinar here
Routinizing rapid response
To be ready for any obstetric emergency, Dr. Nabors and Wesley Davis, MD, Vice President of Clinician Success, offered advice on how to prepare, use evidence-based protocols and debrief to keep patients safe and constantly improve outcomes.
Dr. Nabors started by reviewing the Five R’s from the Alliance for Innovation on Maternal Health (AIM):
- Readiness: Practice and prepare with drills, policies, activation pathways, stocked carts and kit checks.
- Recognition: Look for maternal early warning signs, such as bedside cues, and standardize risk screening.
- Response: Use protocols to automate emergency procedures. Clarify roles according to the team and location and local resources.
- Reporting & Systems Learning: Conduct structured debriefs to support continuous improvement and education. Bring debriefs to QAPI and peer review when necessary.
- Respectful Care: Use a team birth approach or an informal method to include patients in decision-making, planning and debriefing when appropriate.
“Stick to those R’s to cover all of your bases, and you’re going to be ready for any obstetric emergency,” says Dr. Nabors, senior market medical director.
Evidence-based protocols
Clinicians with OBHG proactively serve as maternal safety champions by simply following company protocol. With thousands of OB/GYNs spread across the country, we’re able to standardize evidence-based care and measure its effectiveness.
For example, in the case of a hemorrhage, all OBHG clinicians are trained to follow the same established best practices, and we have data to track how well our clinicians adhere to protocols. This standard of practice has a ripple effect on the local hospitals where OBHG employees work.
“One of the ways we change culture is by being a very data-driven company where all our clinicians focus on the same goals,” says Dr. Davis.
Improving communication
Of all the challenges that can come up in obstetrics, communication shouldn’t be one of them. Dr. Davis offers the following tips to proactively and concretely improve communication on the floor:
- Closed-loop communication: OBHG offers TeamSTEPPS training to our hospital partners. A fundamental part of the approach is closed-loop communication in drills and in real life. “Every time I get a phone call from the nurse, the expectation is I’m going to repeat back to them what they ask.”
- Adhering to protocol: Keep protocols laminated and stored on a ring in each labor and delivery room. Appointing one person to hold a copy of a protocol during labor or during an emergency ensures someone is charged with overseeing each step. “They’re not going to be hands-on on the patient or running to get things. They’re holding the protocol and making sure we’re not missing anything major.”
- Emergency codes: Every hospital uses them, but not everyone practices them to ensure they’re clear. “I’ve actually been at a facility where someone got the code but they didn’t have a clue what it meant or where to go, so make sure everyone practices all the different roles.”
- Clear visuals: Use whiteboards for time stamps (head out, body out), QBL and next steps. This keeps a shared mental model visible.
Design debriefs that improve performance
Improving positive outcomes takes teamwork. This starts with team huddles before any high-risk delivery, followed by debriefing key components and lessons learned later as a group. Delivery floors are no doubt hectic, but it’s critical to find systems that work.
Some hospitals make it easy for nurses to fill out a debriefing form on a Zebra phone, which is then delivered to the labor and delivery manager. Others require a debrief in the moment before the end of the procedure.
After more severe emergencies, especially in the case of a bad outcome, a remote debrief in a safe, judgment-free environment is essential.
“It helps with healing from the potential trauma of that emergency, but also what we can learn once we’ve had some time to think about it,” says Dr. Nabors.
Taking the debrief to QAPI for a separate peer review of the situation can help teams learn from the scenario and incorporate it into future simulations.
Bottom line: Turn excellence into habit
Rapid response isn’t heroic. It comes with diligent, team-based practice of evidence-based protocols. OB hospitalists help make readiness feel routine by regularly practicing until the right moves are automatic. The payoff shows up where it matters most: lower morbidity and mortality, smoother team dynamics and patients who feel informed and respected through it all.
Click here to listen to a webinar on what it’s like to work as an OB hospitalist.
Interested in OB hospitalist careers? Visit our careers page or connect one-on-one with an OBHG clinician to learn how you can make a difference in women’s healthcare.