What Happens When Hospital Obstetric Units Close?


As obstetric units close and consolidate around the country, ways to improve interhospital communication and to assess patient outcomes are needed.

As hospital obstetric units continue to close or be consolidated, policy researchers argue that fragmented care for mothers and babies and the increased demands on the remaining hospital obstetric programs must be addressed.

In the wake of the closure of 13 of 19 hospital obstetric units in Philadelphia County, researchers sought to document the problems faced by the remaining medical workforce. The researchers described a tense environment of sharp surges in patient volumes at the remaining hospitals, eroded workforce morale, and a lack of continuity of care for mothers and babies.

Key Point:

- As obstetric units continue to close and consolidate at hospitals around the country, there may be a need for public health departments to play a greater role in easing the ensuing transition for patients by reducing fragmented care.

In conducting the analysis, researchers interviewed 23 people working at 11 different hospitals with open obstetric units in the region. Six hospitals were in Philadelphia, and five were in the surrounding suburbs; none were identified in the paper. What emerged was a picture of poor interhospital communication that added to the stressful conditions caused by the influx of patients at the remaining obstetric units. These findings support the need for policy makers to anticipate the closures of obstetric units and help to monitor patient outcomes, the study authors concluded.

"While the degree of obstetric unit closures was larger in Philadelphia than in any other metropolitan area, analyzing the situation may provide useful lessons for other areas as hospital consolidations, closures and mergers have accelerated since the enactment of the Affordable Care Act," said study leader Scott A. Lorch, MD, MSCE, a neonatologist and researcher in the Center for Outcomes Research at The Children's Hospital of Philadelphia (CHOP), in a news release.

Especially troubling and difficult was that patient records documenting the prenatal care patients received did not follow them to the delivery room, resulting in fragmented care.

"One clear message from this study is that women need help from their healthcare system in obtaining better continuity of care throughout their pregnancies," said Lorch.

Since hospitals are competing for the patients, Lorch and his colleagues suggested that local health departments must take a role in easing the transition for patients when an obstetric unit is to close. Those interviewed for the study also suggested that having better ways to exchange health information and to standardize protocols among regional providers could improve continuity of care. Putting these ideas into practice could improve the situation for patients and providers, the findings suggested.

The study was published in the December 2014 issue of Health Affairs.

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