Krolikowski-Ulmer Keely, Watson Travor J, Westhoff Elizabeth M, Ashmore Sarah L, Thompson Paul A, Landeen Laurie B
University of South Dakota Sanford School of Medicine, Vermillion, South Dakota.
Sanford Health and Research, Sioux Falls, South Dakota.
S D Med. 2018 Dec;71(12):534-537.
In 2010, the OB/GYN physicians at this mid-sized midwestern medical center implemented a laborist model on the obstetrics ward. A laborist is a dedicated obstetrician within the obstetric ward who oversees the management of labor and performs deliveries as both the primary physician and also when consulted by other providers, including community obstetricians, family physicians and nurse midwives. In 2014, a collaborative obstetric model was implemented with the addition of an in-house certified nurse midwife (CNM) to assist the laborist in obstetric care. This retrospective study analyzes the impact of these care models on clinical outcomes, including rates of induction of labor, total (primary and repeat) cesarean sections, and vaginal births after cesarean section. The three time periods (i.e., pre-laborist, laborist, laborist plus CNM) periods are compared. Induction rates decreased from 48.6 percent to 46.5 percent to 28.8 percent during the three time periods. Primary cesarean section rates decreased from 15.9 percent to 14.6 percent to 13.6 percent. Total cesarean section rates slightly decreased but this was not statistically significant, going from 28.9 percent to 28.4 percent, to 27.7 percent. Vaginal births after cesarean section increased from 9.2 percent to 12.9 percent to 15 percent. Staff satisfaction was also measured utilizing anonymous surveys during the first two time periods. There was improvement in seven of the eight questions from the pre-laborist to the laborist model. In conclusion, a collaborative care model on the obstetric floor at this Institution has had a positive impact on patient care outcomes and staff satisfaction.
2010年，这家位于中西部的中型医疗中心的妇产科医生在产科病房实施了专职产科医师模式。专职产科医师是产科病房内专门负责监督分娩管理并进行接生的产科医生，既作为主要医生独立接生，也在包括社区产科医生、家庭医生和助产士在内的其他医护人员咨询时提供协助。2014年，该医院实施了协作产科模式，增加了一名院内认证助产士（CNM），以协助专职产科医师进行产科护理。这项回顾性研究分析了这些护理模式对临床结局的影响，包括引产率、总（初产和再次）剖宫产率以及剖宫产术后阴道分娩率。对三个时间段（即专职产科医师模式前、专职产科医师模式、专职产科医师加认证助产士模式）进行了比较。在这三个时间段内，引产率从48.6%降至46.5%，再降至28.8%。初产剖宫产率从15.9%降至14.6%，再降至13.6%。总剖宫产率略有下降，但无统计学意义，从28.9%降至28.4%，再降至27.7%。剖宫产术后阴道分娩率从9.2%升至12.9%，再升至15%。在前两个时间段还通过匿名调查对员工满意度进行了评估。从专职产科医师模式前到专职产科医师模式，八个问题中有七个得到了改善。总之，该机构产科楼层的协作护理模式对患者护理结局和员工满意度产生了积极影响。
