Liz Freeman|Naples Daily News
NCH Healthcare System is launchingCollier County's firstobstetrics emergency department,part of long-range plans to advance services for women and children as more families move into the community.
The nonprofit hospital system also contracted with OB Hospitalist Groupto provide 24/7 coverage to expectant women facing emergencies with their pregnancies, to support high-risk pregnancies, and to deliver babies for women who don’t have a local obstetrician.
The obstetrics emergency room, which will open Dec. 24, isin the labor and delivery unit at NCH North Naples Hospital,the only hospital-based birth center in the county. It averages3,400 deliveries a year, according to NCH.
Having an in-house obstetrician at the hospital at all times means a patient can be evaluated immediately for pregnancy-related issues and no longer has to wait for herregular obstetricianto arrive,if she has one, which can improve outcomes for both mother and baby, hospital officials say.
“We basically now have a lifeguard here who is watching what is happening, not just in the (labor and delivery) unit but in the building,” said Dr. Thomas Beckett, chairman of NCH’s department of obstetrics and gynecology.
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On Wednesday, the day the 24/7 emergency obstetrics coverage debuted, Beckett said one of his pregnant patients had an emergency and went to the hospital. He was delayed getting there because of road construction but knew his patient was getting immediate care.
“It was a great buffer. I've already seen that," he said. "Peace of mind in this field has finally arrived in the obstetrics unit. I think that is really huge."
Doctors group also serves Lee County
The same group has providedobstetrician hospitalists for emergencies since 2015 for the Lee Healthsystem in Lee County, according to Lee Health officials.
The OB hospitalist team provides emergency obstetrical services inthe dedicated obstetrics emergency department at HealthPark Medical Center and in the system'slabor and delivery suites. Lee Health averages 7,200 deliveries annually with roughly6,000 at HealthPark and 1,200 at Cape Coral Hospital.
Last year Lee Health had more than 10,000 high-risk visits at HealthPark, and the proximity to the neonatal care unit at Golisano Children's Hospital on the same campus helped make coordination of care seamless if a newborn required the neonatal intensivecare unit, according to hospital officials.
"Caring for high-risk pregnancies in one location allows Lee Health to provide the expectant mothers with an exceptional level of care while improving outcomes for them and their babies," Dr. Eric Appelgren, chief physician executive at HealthPark, said in an email.
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Thelabor and delivery unit at North Naples is the only hospital-based birth center in Collier. Physicians Regional Healthcare System closed its birth center in late 2013 due to low delivery numbers.
For NCH North Naples, the hospitalist organization is providing a six-member team of board-certified obstetricians who are rotating to cover the 24-hour shifts, said Paula DiGrigoli, NCH’s administrative director of women’s and children’s services. The same six physicians will be assigned to the hospital.
The in-house obstetricians are not replacing a patient’s privateobstetrician who has been overseeing the pregnancy and who is planning to perform the delivery, according to NCH.
“This program does not take the patient from her own physician, but rather helps to ensure that every patient, regardless of physician association or the time of day, is seen by an OB/GYN immediately should there be an emergency,” NCH said in a news release.
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The state Agency for Health Care Administration has approved converting five of the hospital'slabor,delivery and recovery rooms for the obstetric emergency department, DiGrigoli said. The unit currently has 19 rooms, Beckett said.
An obstetrics emergency department is dedicated space inside a labor and delivery unit for patients who come in with pregnancy and postpartum-related obstetrical issues, and they are seen by a specialist in obstetric medicine, according to OB Hospitalist Group.
Conditions that can be addressedare abdominal pain, preeclampsia, abnormal vagin*l bleeding, ruptured membranes, increased blood pressure, and detached fetal movement, according to the group. The specialists can also perform labor checks.
More families moving to Collier
Collier has faced steady population growth over the last decade, withmore younger families with children moving here despite the COVID-19 pandemic, DiGrigoli said.
Collier County School District data show local schools grew by more than 3,000 students since last year. There were 45,806 students as of Aug. 13, 2020. Thatnumberclimbed to 48,841 students as of Dec. 15, 2021.
The county's number of births has been increasing in the last two years after declines for several years attributed to the Great Recession of 2007 to 2009, similar to national trends, data show.
The state Department of Health reports there were 3,166 live births in Collier in 2020, for a rate of 8.2 births per 1,000 population. The county's population in 2020 was about 386,000 people — a 20% jump in a decade, up from 322,000 residents in 2010,according to state health data.
In 2019, there were 3,117 live births for a rate of 8.3 births per 1,000 population. The population in 2019 was 378,000.
Based on the state’s figures, Collier gained nearly 8,000 new residents from 2019 to 2020.
U.S. Census data show a lower 2020 population figure for the county, at 376,000, which may be due to migration caused by the COVID-19 pandemic and fewer households completing Census questionnaires, which started hitting mailboxes in March 2020 when the pandemic broke out.
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What else is planned?
The obstetrics emergency department is one element of upgrades planned over five years for women’s and children’s services at North Naples.
NCH announced in May a gift of $5.7 million from the Bill and Julia Van Domelen Foundation to helpprovide more specialized care so fewer premature babies and women with high-risk pregnancies are sent out of the area for medical care.
The plans include upgradingthe current neonatal intensive care unit from a level two unitto a level three unit in order to care for premature infants weighing under 2.2 pounds.
Making the change means hiring more nursesbut will not require new construction, DiGrigoli said. The hospital hopes to get more answers from the state on what's needed in January.
NCH’s 19-bed neonatal intensive care unitis able to care for premature infants who weigh more than 2.2 pounds. The upgrade will meantransferringfewer premature infants to other hospitals, often Nicklaus Children’s Hospital in Miami.
About 10% of newborns at North Naples are transferred, which creates hardships for the families. The goal is to cut thetransfer rate in half with a level threeneonatal unit.
Pediatric surgery and anesthesiology upgrades are also planned, along with morepediatric imaging.
Are private obstetricians on board?
Having 24/7 obstetric emergency room coverage is an essential element of NCH'splan for women and infants to stay in the community for the care they need, DiGrigoli said.
A committee this past spring was formed with the roughly 20 private obstetricians in the community to discuss options for providing 24/7 obstetrician coverage at the hospital.
Beckett said about one-third of the physicians wanted to hire an outside group, like OB Hospitalist Group, to provide the coverage and so the local physicianswould no longer use an on-call system. About two-thirds of the local obstetricianswere flexible.
The local obstetricians voted in the spring to hire the OB Hospitalist Group, andthey were invited to take part in Zoom interviews of the hospitalist candidates for North Naples, he said.
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The OB Hospitalist Group, based in Greenville, S.C., stateson its website that it is the "nation’s largest and only dedicated provider of customized obstetrichospitalist programs" and it operates at 200 hospitals in 33 states.
The group was founded in 2006 by an obstetrician who developed the concept of an obstetrics emergency department to address concerns that pregnant women in emergency rooms at odd hours were often seen by nurses and managed by their doctor over the phone, according to the group's website.
NCH said the group's contract is for three years.
With the start of the OB hospitalist team at North Naples, the local obstetricians will no longer have to be on call for obstetrical coverage at the hospital, but they will still be doingcalls for emergencies involving gynecological issues, Beckett said.
Having an obstetrician in-house at all times as a safety netshould have been started years ago, Beckett said.It provides him with a level of comfort that his patients are getting the proper attention until he can get to the hospital in an emergency.
"I didn't have that luxury in the past," he said.
