The Impact of Obstetrician/Gynecologist Hospitalists on Maternal Quality of Care in Yogyakarta Indonsia: A Cohort Study

https://doi.org/10.22146/jkr.35421

Eugenius Phyowai Ganap(1*), Mohammad Hakimi(2), Soerjo Hadijono(3), Ova Emilia(4)

(1) Departement of Obstetrics and Gynecology, Faculty of Medicine, University of Gadjah Mada
(2) Departement of Obstetrics and Gynecology, Faculty of Medicine, University of Gadjah Mada
(3) Department Obstetrics and Gynecology, Faculty of Medicine, University of Diponegoro
(4) Departement of Obstetrics and Gynecology, Faculty of Medicine, University of Gadjah Mada
(*) Corresponding Author

Abstract


Background: The hospitalist is defined by 24-hour a day/7 day a week physician who assists or is employed by the hospital to manage patients, triage and emergencies.  The hospitalist model in obstetric care that was introduced over the last decades now has an important role in care delivery management with the potential positive impact on maternal outcomes. Unfortunately, in Indonesia there were limited data available related to the implementation of hospitalist model and the impact on maternal quality of care.

Objective: To determine the impact of obstetrician/gynecologist hospitalist on maternal quality care. Method: This research design was a retrospective cohort. Participants included were the patients in the time before and after implementation of obstetrician/gynecologist hospitalist policy during October 2013 until September 2014. Univariate and multivariate analysis were conducted to evaluate and determine the factors, which significantly contribute to maternal outcomes.

Result and Discussion: We included a total of 71 patients (30 in the on-call group and 41 in the full time hospitalist group). Univariate analysis indicated mean response time was significantly different in the hospitalist group compared to the on-call group (65.3 ± 25.89 vs 84 ± 22.29 mins; p = 0.002). Implementation of full-time hospitalists did not impact the ICU admission and transfusion incidence.

Conclusions: Implementation of the full-time hospitalist model was associated with a significant improvement of response time in emergency obstetric care without affecting maternal outcomes.

Keywords: Maternal mortality, obstetrician/gynecologist hospitalist, labor and delivery, maternal care, ICU response time


Keywords


Maternal mortality; obstetrician/gynecologist hospitalist; labor and delivery; maternal care; ICU response time

Full Text:

PDF


References

  1. Badan Pusat Statistik-Statistics Indonesia (BPS) National Family Planning Coordinating Board Ministry of Health ORC Macro: Indonesia Demographic and Health Survey 2007. Calverton, Maryland: BPS and ORC Macro. 2008. https://dhsprogram.com/pubs/pdf/FR218/ FR218%5B27August2010%5D.pdf 
  2. Statistics Indonesia (Badan Pusat Statistik— BPS), National Population and Family Planning Board (BKKBN), and Kementerian Kesehatan (Kemenkes—MOH), and ICF International. 2013. Indonesia Demographic and Health Survey 2012. Jakarta, Indonesia: BPS, BKKBN, Kemenkes, and ICF International. https://dhsprogram.com/pubs/pdf/ FR275/FR275.pdf 
  3. WHO, UNICEF, UNFPA and The World Bank estimates. Trends in maternal mortality: 1990 to 2013. http://apps.who.int/iris/bitstream/ 10665/112682/2/9789241507226_eng.pdf 
  4. Putra, M.P., Yudha, editors. Menkes: Angka Kematian Ibu Melahirkan Masih Tinggi [Internet]. Jakarta : Republika; 2013 [cited 2013 May 5]. Available from: http://www.republika.co.id/berita/ nasional/daerah/13/02/16/mi9ugy-menkes-angkakematian-ibu-melahirkan-masih-tinggi 
  5. Thaddeus S, Maine D. 1994. Too far to walk : maternal mortality in context. Soc Scie Med. Apr; 38(8):m 1091-110. 
  6. Widawati. 2008. Faktor yang mempengaruhi pola pemilihan penolong persalinan di kecamatan bojongloa kidul, kota bandung tahun 2007 [thesis]. Universitas Indonesia. 
  7. Wachter RM, Goldman L. 1996. The emerging role of “hospitalists” in the American health care system. N Engl J Med; 335:514-7. 
  8. Olson R, Garite TJ, Fishman A, Andress IF. 2012. Obstetrician/gynecologist hospitalists: can we improve safety and outcomes for patients and hospitals and improve lifestyle for physicians?. Am J Obstet Gynecol; 81-6. 
  9. Chauhan SP, Roach H, Naef RW, et al. 1997. Cesarean section for suspected fetal distress. Does the decision-incision time make a difference? J Reprod Med;42:347-52 
  10. National Institute for Health and Care Excellence. Clinical Guideline : Caesarean Section. London, UK : NICE 2011. 
  11. Sibuea H. 2007. Manajemen Seksio Sesarea Emergensi: Masalah dan Tantangan. Pidato pengukuhan Guru Besar Bidang Kebidanan dan Penyakit Kandungan Universitas Sumatera Utara. 
  12. Feldman DS, Bollman L, Friedman M et al. 2015. Do laborists improve delivery outcomes for laboring women in California community hospitals? American Journal of Obstetrics and Gynecology: 213(4): 587e1-587e13. 
  13. Srinavas SK, Small DS et al. 2016. Evaluating the impact of the laborist model of obstetric care on maternal and neonatal outcomes. American Journal of Obstetrics and Gynecology, doi: 10.1016/j. ajog.2016.08.007. 
  14. Goffman D, Broadman M, Arnold AJ, et al. 2014. Improved obstetric safety through programmatic collaboration. J Healthc Risk Manag. 33(3):14–22.



DOI: https://doi.org/10.22146/jkr.35421

Article Metrics

Abstract views : 519 | views : 217

Refbacks

  • There are currently no refbacks.


Copyright (c) 2018 Jurnal Kesehatan Reproduksi



Jurnal Kesehatan Reproduksi Indexed by:

 



SEKRETARIAT JURNAL KESEHATAN REPRODUKSI
Departemen Obstetri dan Ginekologi, FK-KMK, UGM/RS Dr. Sardjito
Jl. Kesehatan No. 1, Sekip Utara, Yogyakarta 55281
Tlp: (0274) 511329 / Faks: (0274) 544003
Email: jurnal.kesehatanreproduksi@ugm.ac.id
Cp: Dwi Astuti +6281802698043