An obstetric hospitalist is an obstetrician/gynecologist physician (OB/GYN) who is employed by either a hospital or a physician practice and whose duties include providing care for laboring patients and managing obstetric emergencies.
The obstetric hospitalist works only in the hospital in Labor and Delivery.
This means that there is always a physician present who can care for pregnant women — 24 hours a day, 7 days a week.
Hospitalists have worked to change the reputation and expectations of physicians at higher risk of Medical Malpractice Insurance claims owing to their itinerant schedule.
Since they only work in hospitals, they don’t have the benefit of prior patient relationships.
They have changed their challenge to establish a solid, trusting physician-patient relationship, starting with the important function of patient records.
These physicians dug in on the issue of communication, lots of communication: from one provider to another; from nursing staff and medical assistants to physicians and surgeons; from pre-op to post-surgical to rehabilitation.
From the ICU to the emergency room, hospitalists began to study and in service work an understanding and implementing effective communication skills and best practices.
The endorsed carrier of the Society of Hospitalist Medicine – The Doctors Company – studied 464 claims over a 15-year period.
They aggregated the results to summarize the top three reasons hospitalists get sued:
▪︎ 36% of the lawsuits were misdiagnosis claims (missed, delayed, incorrect)
▪︎ 31% of the suits claimed improper management or mistreatment
Top 10 Risk Mitigation Strategies for Hospitalists
The following strategies may help hospitalists avoid some of the issues uncovered by this study.
- Ensure effective handoff procedures during hospitalization and at discharge.
- Communicate with everyone involved in the patient’s care, including the patient, family, prior treating physician, and patient care team members.
- Introduce yourself and your role.
- Sit down and talk to the patient using their name and eye contact.
- Document your plan and rationale, including any changes in an established plan.
- Be sure to document any patient noncompliance.
- Use quotes for patient comments related to noncompliance.
- Evaluate the need for physical examination when notified of a change in an inpatient’s condition.
- If in doubt, go see the patient for a bedside evaluation.
- Be mindful of what you tell nursing staff on the phone as they will chart your exact comment with quotation marks.
- Always consider a differential diagnosis early in treatment.
The Nuances of Insurance Options
Insurance companies should be committed to the unique type of practice within the specialty of hospitalist medicine.
Studying claims, sharing protocol and best practices, giving risk management tips, and informing underwriters of the
difficulty of providing 24/7 staffing are all important details that comprise these policy contracts.
Providing an affordable and sustainable medical malpractice policy requires a flexible roster endorsement providing a $1,000,000 per-claim limit shared amongst the staff with a high aggregate.
This structure provides active liability insurance for the physicians presently filling the schedule. In addition,
the policy provides tail coverage so that claims presented against departed physicians are also covered.
The insurance carrier can offer physicians automatic tail coverage, often referred to as “rolling IBNR.”
For example, normally, a radiologist who is part of a group with traditional malpractice coverage has to protect him or herself when leaving the group by purchasing an individual tail policy.
But with a rolling IBNR policy, physicians are included as insureds.
If a physician leaves the group during the policy period, the physician’s IBNR exposure will remain with the policy of the named insured (e.g., the imaging center) for as long as coverage is in force with the insurance carrier.
Departed physicians will continue to be insured for medical professional services that were provided at a scheduled location while they were employed or contracted by the facility.
As long as coverage is in force with the carrier, claims for medical professional services by the physician can still be reported per the provisions of the policy form.
Should the facility’s policy with that carrier terminate and they are unable to buy continuous prior acts coverage under the same terms, the facility can exercise its right to purchase an extended reporting period, and the carrier will issue an endorsement for all of that policy’s exposure (including both active and departed physicians).
Many organizations also need flexibility in their policies to address the movement of multiple physicians on and off their payroll or who are working on a part-time basis.
There are additional methods of accommodating all of the physicians needed in order to fill the schedule.
Some of the full-time physicians might be on the rolling tail roster while those working limited hours, part-time, or even just once or twice a month would be better suited for a slotted policy.
The slot concept allows you to insure the position as opposed to an individual physician.
If, for instance, you wanted to insure a couple of radiologists, each of whom performs the same duties for a set number of hours per week (up to a maximum of 40), you could do so utilizing a slot endorsement.