This is “Healthy Conversations,” a podcast presented by Adventist Health.

Maggie McKay (Host): Have you heard the term hospitalist or OB hospitalist? What is their job and what's the difference between the two? Today, we're going to find out with our guest, Dr. Elizabeth Emberley, site director for OB Hospitalist Group.

Host: This is Healthy Conversations. I'm Maggie McKay. Thank you so much for joining us today, Dr. Emberley.

Dr Elizabeth Emberley: Hi, Maggie. Thanks for having me.

Host: I'm so excited to hear more about this because I have to say I don't know what a hospitalist is and what you do. So, tell us.

Dr Elizabeth Emberley: Yeah. It's a very common question actually. A hospitalist is specifically a physician, a provider who does not have an office practice. I'm not going to say never has an office practice, but typically does not have an office practice. We focus primarily on hospital patients, patients in the hospital who need that hospital level of care.

Host: And how does an OB hospitalist differ from other hospitalists?

Dr Elizabeth Emberley: Another good question. So, an OB hospitalist or an OB-GYN hospitalist is an obstetrician, a gynecologist, who handles hospital patients for OB-GYN problems specifically. Other hospitalists might be internal medicine hospitalists dealing with medical problems, problems like diabetes or high blood pressure in someone who is not pregnant. A pediatric hospitalist is someone who would deal with specifically the pediatric patient. So, an OB-GYN hospitalist is someone who specifically is in the hospital dealing with OB-GYN problems.

Host: And is that because their main doctor is at their practice in their office busy?

Dr Elizabeth Emberley: The situations vary. So, there are times when your OB-GYN is in the office during office hours, or maybe it's the weekend or after office hours. Your OB-GYN may be home for the evening or on a weekend or a holiday. We are in the hospital 24/7 to make sure that you have access to an OB-GYN in any situation. We're also in the hospital for patients who maybe are in from out of town and their OB-GYN is not in this town. They do not come to this hospital. We also cover a variety of other different situations.

Host: That is reassuring. I never knew that and I always thought, "What happens when you're out of town?" So, now we know. What are the benefits of having an OB hospitalist at the hospital?

Dr Elizabeth Emberley: We already touched on some of them with my previous answer. But I think the biggest benefit is that, if you walk in the door and you need an OB-GYN, there is one there for you. Regardless of whether your doctor comes to the hospital, regardless of whether you are from out of town, there is an OB-GYN in the hospital 24/7 to take care of you.

Host: That's great. How do you work with private practices in the community and do you ever care for patients who have a private physician?

Dr Elizabeth Emberley: Absolutely. So, we do partner with the private practices in the community to make sure that the patients that are seen in the office and they don't have a delay in care because maybe their doctor might have to run over to the hospital to do deliveries or C-sections in the case of not having a hospitalist in the hospital. Having the hospitalist in the hospital enables us to evaluate patients who come in who see those private practices, and that provider does not have to leave the hospital during the office day to come over as frequently to the hospital to handle those issues.

Host: Can you tell us about a case that was life or death and the patient was saved because a hospitalist was there?

Dr Elizabeth Emberley: Yeah. We have many, many of these stories and it's unfortunate because we never want to have an emergency. But emergencies in obstetrics do happen, and they do happen on a regular basis. The one that would come most quickly to mind is the case of a condition called placental abruption. What happens with a placental abruption is that, for whatever reason, the placental interface with the uterus is disrupted. And when that happens, the placenta is very, very vascular, has a very rich blood supply because, of course, it is supplying blood to the growing baby inside the mom. In a placental abruption, you suddenly may have abdominal pain. The baby's heart rate may have abnormalities where the heart rate drops unexpectedly, and you may suddenly start experiencing vaginal bleeding. In these cases, it is imperative to have delivery as quickly as possible for the safety of mom and safety of baby. And we actually have this on a very regular basis where you can't predict it happening. Unfortunately, it does happen. But we are there to immediately be present at your bedside, either expedite delivery vaginally or move for a C-section delivery as quickly as possible.

Host: Well, that's got to make pregnant women so happy to hear that before they go in. Do you tell people-- because I remember, when I was in the hospital for my son, I never heard of a hospitalist. I mean, I'm sure they had them, but they never mentioned it. So now, do you inform the patients that if your physician is not available we have hospitalists. Do they tell patients?

Dr Elizabeth Emberley: We do try to tell patients, because it is a very big benefit of having a hospitalist program at specific hospitals. When I see patients in the obstetric emergency evaluation area, I introduce myself as the OB-GYN hospitalist in the hospital today so that they know that they are seeing an OB-GYN hospitalist. Along that line, Maggie, we also tried to get out to the community the fact that at Tenet Sierra Vista, we are there at the hospital 24/7. And that doesn't just include partnering with the private practices in the community, this also covers a group of patients that we might term uncovered patients. Specifically, these are the patients that their doctor does not come to our hospital or from out of town, but that also includes other patients from the community, patients who maybe are trying to have a home birth, patients who are being cared for by midwives in the community. These are a very special population. They're trying to minimize their hospital stay. They're trying to have a home birth experience, a midwife birth experience, but for whatever reason, they end up needing to come to the hospital. Sometimes that looks like pushing for three hours, four hours, and wanting to have an epidural or their labor stalls and need to come to the hospital for further management of care. We are there in the hospital to make sure that these patients have a provider and they feel warmly welcomed and exceptionally cared for.

Host: Dr. Emberley can you tell us more about the obstetric emergency department?

Dr Elizabeth Emberley: Absolutely, Maggie. The obstetric emergency department is actually very near and dear to my heart. This is an area off of labor and delivery where obstetric patients can be evaluated by a trained obstetrician gynecologist. This is separate from the main emergency room. So, this would cover pregnant women with an obstetric problem, things like contractions, cramping, vaginal bleeding. Other issues may be shortness of breath or chest pain. Those will still be evaluated in the main emergency room of the hospital. But this area, the obstetric emergency department, is a very specialized area where we can ensure that pregnant women who are having pregnancy-related complaints can be cared for by an OB-GYN, because we specialize in those problems and concerns.

Host: Does every hospital offer that for the ER, specifically for OB-GYN issues?

Dr Elizabeth Emberley: No, actually. This is something that is very special and very unique to Sierra Vista in this area. More and more hospitals are picking up an obstetric emergency department or an obstetric emergency assessment area. And I would like to see that incorporated in more hospitals in the area. But for right now, this is a very unique thing at Sierra Vista that we can provide for our patients.

Host: What are the most common types of OB cases you see?

Dr Elizabeth Emberley: We see a lot of different variety of patients in the obstetric emergency department. Our most typical would be rule out labor, patients come in with cramping or contractions, patients who think that their water has broken. We're able to evaluate that and decide for either going home, maybe they're in early labor and need to be discharged home until they're in labor, active labor, or whether they need to be admitted to the hospital. Other concerns that we may see is pelvic pressure and maybe the patients have urinary tract infections. Another common patient that we see in the obstetric emergency department is decreased fetal movement. So, moms who are at home and they're not feeling the baby kick and move as much or at all during the day as they have been. We are there to evaluate them and make sure that there's nothing going on with the pregnancy or the baby.

Host: What percentage of your job do you spend in the ER or working on ER cases or GYN cases?

Dr Elizabeth Emberley: So, the answer to this is in several parts. Obstetric emergency department, specifically, we spend probably a good 50% or 60% of our time in. The main emergency department is a different story, and that also can vary depending on the hospital site that you are at. I probably spend about five to 10% of my time in the main emergency department. This mostly encompasses gynecologic cases that come into the main emergency department

Host: Dr. Emberley, what common GYN cases does an OB hospitalist see?

Dr Elizabeth Emberley: We see a wide variety of emergency cases that may present to the main emergency department. Of course, we handle any patients who come in who don't have a doctor in the area for gynecologic complaints. But typically, we may see things like heavy periods where patients may be anemic because of how much they are bleeding. Cases like ectopic pregnancy, an ectopic pregnancy is a pregnancy that has established itself somewhere outside of the uterus, whether that be in the cervix, whether that be in the fallopian tube or whether that be in the abdomen. We covered those pregnancies, the ectopic pregnancies, because they are a life-threatening emergency. We also see patients who have ovarian cysts, and maybe they are painful or maybe they have an ovarian cyst that has caused their ovary to flip over on itself, and that is a situation called ovarian torsion. Those cases are where the blood flow to the ovary actually is cut off because the ovary has flipped over and is extraordinarily painful. And we need to go in surgically and unflip the ovary to maintain good blood flow to the ovary.

Another common thing that we see in the emergency department is retained products of conception. This is a case that is actually not that common, but where maybe a portion of your placenta remained stuck inside the uterus after delivery. Most typically, we see that present immediately after you deliver in the hospital as heavy bleeding. But in some patients, they may have delayed bleeding after they've been discharged and gone home from the hospital. So if that happens, we are there to take care of them on an emergent basis and to make sure that they receive the care that they need.

Host: Oh my gosh, there are so many things that can go wrong. Thank goodness for you devoted physicians who take care of all these issues. Because you know what, it's hard enough being pregnant, but to have all these worries. I mean, hopefully going in, you don't know about all the things that can go wrong, but if you did, it'd be like, "Aye yai yai." Dr. Emberley, do you have anything else to share in closing?

Dr Elizabeth Emberley: The one thing that I wanted to say at the end is just that OB-GYN hospitalists, hospital medicine is our passion. We have a strong desire to make sure that every single pregnant woman or GYN emergency is treated with the utmost care and respect. And we serve as partners with the hospital and as team players with your private practice, your midwife, your home birth experience. So, I hope that you feel like you are in extraordinary hands.

Host: It sounds like it. Thank you for your work. I mean, it is appreciated. It is amazing what you do there every day, day in and day out. This has been so eye-opening and so interesting. Thanks for sharing your knowledge with us and explaining what an OB hospitalist is and does.

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Disclaimer: This program is a community service and is not intended to be a substitute for medical advice. Listeners having questions about their health should make an appointment to see their personal physician. Any opinions or statements made during the program are those of the individuals or physicians making the statements and are not the opinions or statements of the hospital.