Dr. David Vallejo: Early on, we had discussions with the emergency department regarding postpartum preeclampsia and when to call us so we can get involved early on in these cases. The emergency department team also contacts our team about ectopic pregnancies and other OB GYN cases. The line of communication between the OB hospitalist team and the emergency department is quite open, which creates a good working environment and improves overall care for the patient.

Scott Webb (Host): That's Dr. David Vallejo, a Board Certified OB GYN and OB Hospitalist with OB Hospitalist Group and Site Director of OB Hospitalists at Ascension St. Joseph Medical Center. And today, Dr. Vallejo is going to talk to us about the collaboration that occurs between OB Hospitalists and the Emergency Department and how the collaboration improves maternal care. This is the Obstetrics Podcast from OB Hospitalist Group.

I'm Scott Webb.

So just getting rolling here, Dr. Vallejo, I want to have you set the stage for us. You know, at hospitals with an OB ED or obstetrics emergency department, pregnant patients don't report to the ED, they go to the OB ED. But there are some cases where patients go to the ED and maybe it's after they deliver. So can you briefly explain when patients go to the ED instead of the OB ED?

Dr. David Vallejo: Just in talking about the OB ED specifically at Joliet, so, early on, you know, we were trying to determine who should be seen in the OB ED and specifically who should be seen still in the main ED. So one of the criteria that we came up with was determining the gestational age and through discussions kind of early on; we determined that patients who were 20 weeks and above with an obstetrical complaint should be seen by the OB ED.

And the OB ED is staffed by Board Certified Obstetricians and Gynecologists, and that is what we do. So, we're there to serve these patients who are coming in with some sort of obstetrical complaint. In terms of ED and pregnant patients who are seen still in the main ED, would be those patients who are less than 20 weeks.

 They can still consult us if there's some question as to what may be going on, or in some instances, we may feel that even though the patient is less than 20 weeks, she may be better served by seeing us in the OB ED. We would bring that patient up. So there is a lot of conversation between the emergency room physician and the on call hospitalist about where is the patient going to be best served.

Host: Yeah, that's awesome. Sounds like open lines of communication and sort of a triage system, if you will. So, when the OB hospitalist program began at the hospital, how did you establish that relationship with the ED? It sounds like that's really important, but maybe you can explain how you sort of began reaching out to them, creating this relationship, having these open lines of communication so that ultimately there's less confusion when patients show up.

Dr. David Vallejo: Sure. Early on in the creation of kind of the hospitalist program and the OB ED, you know, we did try to reach out to the head of the ED, nursing staff, and people who are involved in just the day to day care of the ED patients and trying to come up with workflows. That way there would be less confusion as to who should be seen in the OB ED, who should still be seen in the main ED. And even to this day, you know, there's still a lot of questions that I think are a lot of gray. And I think the one perk about having us in-house is that they can call us, right? So we carry the phone with us 24-7 and if there's any doubt, you know as to hey where is this patient going to be best served, they'll call us and say hey, this is a situation I have, what do you think we should do? Again, you know, at the end of the day, it's about patient care and where is this patient going to be best served. So, leaving those lines of communication, trying not to be too rigid with the workflows, I think works best at least in our situation, because a lot of the time, there's still a lot of gray areas, and so, again, it's really about open lines of communication.

Host: Yeah. It does sound open lines really a collaborative effort. How often would you say when like when you're on call, when you're working, how often would you say you're communicating with the ED?

Dr. David Vallejo: it's not uncommon that we're getting several phone calls from either mid level providers, or also the ER docs themselves, and it's not always pregnant patients. We do also consult with other type of gynecological patients. So, patients who may be presenting to the emergency room for heavy menstrual bleeding, pregnancy of unknown location or other gynecological issues. And so sometimes they just want to bounce their plan of care with us and be reassured that, hey, this is appropriate care for this patient. And other times, you know, they do want to have an official consult. So we'll go down to the emergency room and do an official consult for these patients as well.

Host: Yeah. And obviously, patients who go to the ED, there's doctors and nurses there, trained doctors and nurses, but I'm sure that, especially as it relates to your field or the OB GYN side of things, I'm sure you offer some trainings or simulations. Maybe you can take us through that a bit.

Dr. David Vallejo: We do do you know, simulations, especially for preeclampsia and postpartum preeclampsia. So, reaching out to our ED counterpart because these patients will be presenting initially to the ED when they sign in and especially our postpartum patients. So, postpartum preeclampsia is not an uncommon situation.

And I think one of the things that we try to really hone in on our ED counterparts is letting them know that high blood pressure for us is very different than high blood pressure for the rest of the population. So we really are looking for very specific numbers that are concerning to us.

And I think initially on, we kind of opened up some people's eyes about like, oh man, that's not a blood pressure we would be concerned about. So I think that education helps them kind of really identify these patients quickly on, so that way we get involved in those cases early on and you know, sometimes we will tell them, Hey, you know what? She shouldn't be waiting down there. Bring her up. We'll see her up here and go from there.

Host: Yeah. As you say, there's a lot of gray and yeah, there's that line of 20 weeks, but a woman who shows up less than 20 weeks, who has let's say, high blood pressure or anything else, obviously, as you say, you'd want them moved to where you guys are and those open lines of communication and just everybody working together, obviously, for the best patient care possible is awesome. What happens when a woman shows up at the ED with postpartum symptoms?

Dr. David Vallejo: Depending on the symptoms that she's experiencing, I would say that most of the ED staff knows to get us involved rather quickly. So again, you know, they may kind of triage her and get her into a room, but at the same time, they're placing a phone call to us and letting us know kind of what's going on, what the situation is, and then we can work together to collaborate to determine again, where is this patient going to be most appropriately seen?

And sometimes we're like, it's okay if the patient stays down there. We're going to see her down there right now.

Host: Right. come to her. Yeah.

Dr. David Vallejo: Exactly. Exactly and you know, I always say that the our main goal is making sure that patients are taken care of.

Host: So doctor, it sounds obviously that you work really well with the ED there, the docs, the nurses, and whether it's triaging, communicating, you going to the patients, them bringing the patients to you, all the good stuff we've talked about today. But how about the other departments within the hospital, whether that's the OR, PAs, and so on?

Dr. David Vallejo: Yeah, sure. We are available to all departments within the hospital. So I would say, besides the ED, the other main bulk of patients that we see are going to be inpatient consults. So, patients may be coming in and they may let their primary team know that, Hey, I've been having some abnormal uterine bleeding, or I've been experiencing some postmenopausal bleeding.

And at that point, they would consult us as being the OB hospitalist on call, and then we would get involved in their care and helping them determine a plan. In terms of the OR, there have been instances where a general surgeon may be taking a patient back for something completely unrelated; and lo and behold, they see a cyst or something abnormal while they're in the operating room. And so there have been times where we've been consulted intraoperatively to come in and basically give them second eyes. So that way we can give our expert opinion as to how to manage, whether it be an annexal mass or some other abnormal finding that they noted at the time of surgery.

Host: Sounds like whomever's on call has the phone, and everybody has your phone number, right?

Dr. David Vallejo: Yes. Yeah. So we are very readily accessible.

Scott Webb: That's awesome. Well, this has been really educational and fun today. Doctor as we wrap up here, just what do you wish hospital leaders knew about this great relationship between OB hospitalists like yourself and the ED?

Dr. David Vallejo: Sure. I think one of the things that I would impart on different hospitals is that having 24-7 hospitalist coverage is very important for patients, because we're readily available to respond to different emergencies. So whether that be obstetrical emergencies, gynecological emergencies; we are there as that first line of defense for even if it's a private patient and let's say they have a laboring patient who for some reason is starting to crash; we would be the ones readily available to start that C-section for them.

And hopefully they're not, you know, flying 90 miles per hour to get to the hospital because they know they have that safety net, which is us to respond to those emergencies.

Host: Yeah, it is an added layer of security to have OB hospitalists there and to have this great relationship with the emergency department. So thank you so much and you stay well.

Dr. David Vallejo: Thank you so much.

Host: That's Dr. David Vallejo, and for more information about OB Hospitalist Programs, go to obhg.com. And if you found this podcast to be helpful, please share it on your social channels and make sure to check out the entire podcast library for additional topics of interest. I'm Scott Webb, and thanks for checking out this episode of the Obstetrics Podcast from OB Hospitalist Group. Take care.