Design: Retrospective analysis of Prospectively collected data from a System-Based intervention

Setting: Large metropolitan city

Patients or Participants: Medical practice comprising 185 faculty

Interventions: Mandated, fee-for-service, separate Gyn/MIS Back-Up call schedule.

Measurements and Main Results: In the past 10 years, our academic and community ObGyn practice has expanded to cover 8 Hospitals including academic, community and county centers. We anticipated the challenges of the increase in patient volumes and call burden, and we committed to provide safe, quality care while reducing liability. A Hospitalist/Gynecologist-MIS Back up program was created.

In addition to the hospitalists focusing on Ob triage/L&D and emergencies, 20 Gynecologists, available within 20 min, rotate to cover weekly back up nights. Compensation for each encounter/surgery is equal to 12 hours of in-hospital call. 240 gyn back up encounters occurred within 2.5 years (at full expansion). The mean monthly number of calls was 8 calls (SD = 4). Of 206 gynecologic surgeries, 89% were done via the minimally invasive route (153 laparoscopies, 30 vaginal surgeries). The most common indication for surgery was laparoscopic management of ectopic pregnancy (38%) followed by ovarian torsion (25%). Laparoscopic procedures also included treatment of complex cases that would have otherwise had open surgery (ruptured tubo-ovarian abscesses, endometriomas and ectopic pregnancies with over 1500 mls of hemoperitoneum). 13% of the back-up calls were made to assist the hospitalist in case of complex obstetrical surgeries (cesarean hysterectomy for abnormal placentation and hemorrhage).

Conclusion: Our Gynecology/MIS Back Up call system covering 8 hospitals, provided Quality and Safe care for women, while assuring minimally invasive gynecologic services in a large academic and community medical practice.