David Redfern, M.D., returns to St. John’s to lead new OB hospitalist program
April 30, 2008

Nov. 17, 2004 is a date that stands out in Dr. David Redfern’s mind.

Before returning to St. John’s in March to lead a new hospital-based OB/GYN or “laborist” program, Nov. 17, 2004 was the last time Dr. Redfern had delivered a baby. 

“I significantly missed delivering babies and taking care of pregnant women,” says Dr. Redfern, who in 2004 switched to an all-GYN practice with his then-partners at the independent Woman’s Clinic.

Now, as an OB hospitalist for St. John’s, caring for pregnant women and delivering babies are all Dr. Redfern does. He works four to five 12-hour shifts a week and when he’s off work, he’s really off work.

St. John’s is one of a growing trend of hospitals in the nation to employ hospitalists, or hospital-based physicians, to provide care for patients whose primary care physician is unavailable – either temporarily or during the length of a patient’s hospital stay or delivery.

St. John’s Hospital’s internal medicine hospitalist program began in 1997 and has been credited for producing shorter hospital stays, improved treatment results and increased patient satisfaction. A similar program is in place for the hospital’s pediatrics floor. St. John’s Hospital-Lebanon recently launched its own internal medicine hospitalist program, with providers from the Springfield hospital taking shifts at the Lebanon facility.

“Hospitalists manage the care of acute patients and to allow clinic physicians to focus on preventive disease management and prevention of chronic disease,” says Dr. Weldon James, family medicine physician. “It’s a great working relationship, communication is open and free flowing. It just leads to better patient care.“

Currently, Dr. Redfern is St. Johns’ only OB hospitalist. The goal is to staff the program with two additional board-certified, experienced OB/GYNs within six months, Dr. Scarrow says.

St. Johns’ OB hospitalist program works by having a dedicated OB physician on-site at the hospital to care for laboring patients who don’t have a physician and also to assist the OB/GYNs with their laboring patients.
Benefits to hospital patients include access to a board-certified OB/GYN upon arrival at the hospital instead of waiting for their physician or the on-call physician to arrive.

Benefits to clinic patients include fewer appointment cancellations due to their physician being called out of the office for the entire day to deliver a baby during office hours, a more rested and attentive OB/GYN, and fewer interruptions during appointments.

“The impetus for starting this program was to improve both patient safety and quality of care, for the hospital patient and the clinic patient,” says Meera Scarrow, M.D., OB/GYN section chair for St. John’s. 

 “The model of care where the OB/GYN juggles clinic, emergency room call, surgeries and deliveries – sometimes all at once – is simply outdated and really not good for anyone,” she says.

Dr. Redfern agrees, recalling times throughout his career when he was up several nights in a row delivering babies or taking emergency call.
“You’re burning the candle at both ends. During weeks like that, you’re tired and not as attentive and patient as you should be with your clinic patients during the day, and family life takes a backseat,” he says.

Dr. Scarrow emphasizes that the OB hospitalists will not replace the patient’s OB/GYN when the patient delivers, unless the OB/GYN is out of town or otherwise unavailable. Previously, in these cases, patients would be cared for by the on-call physician who would have to drive in from home unless they were already at the hospital.

“All of the OBs I know plan to continue delivering their own patients as much as possible … frankly, delivering babies is why most of us get into obstetrics and gynecology in the first place,” Dr. Scarrow says. “Our OB/GYNs truly want to be at their patients’ sides for each and every delivery and be involved in the decisions that occur prior to delivery. This program is just an additional layer of physician care and oversight to allow the highest standard of care and safety to all women delivering at St. John’s.”

The OB hospitalists assist the OB/GYNs by starting the patient’s care immediately upon arrival at the hospital, Dr. Scarrow explains, such as by breaking the patient’s water if needed, ordering an epidural, starting a C-section and otherwise monitoring the laboring patient and baby’s conditions at the OB/GYN’s direction until he or she can get there –unless the OB/GYN has planned ahead of time to be out of town or otherwise unavailable during that time. In that case, the OB hospitalist acts as the patients’ OB/GYN throughout her hospital stay.

“Our role is to fill in the gaps and act as a natural extension of the OB/GYN,” Dr. Redfern says.

For St. John's OB/GYNs, those physicians may utilize the OB hospitalists to assist in the management of their patients, allowing more time attending office patients and decreasing the time spent leaving the office for a quick round trip to Labor & Delivery. Additionally, the OB hospitalist may respond to emergency situations while the OB/GYN is in route.

For the time being, the OB hospitalists cover only Labor & Delivery at St. John’s Hospital; the OB/GYNs are still required to regularly take call for the emergency room. That may change as the program grows, Dr. Scarrow says.

With around 5,000 deliveries under his belt, Dr. Redfern was a natural choice to lead the new program, she says.

“Our goal was to first get an experienced leader in place to get the program off the ground, and we knew we had that in Dr. Redfern,” Dr. Scarrow says. “For the staff in L&D, his coming back has been like an early Christmas present. They just love him up there.”

Returning to St. John’s has also been a welcome homecoming for Dr. Redfern.

“I missed the labor and delivery staff at St. John’s. Coming back has been very positive for me and I see that a lot of positive changes have taken place since the last time I was here. This is an exciting time to be at St. John’s.”