Pediatric Hospital Medicine in the Delivery Room: A 14-Month Retrospective Study

Background: Pediatric Hospital Medicine (PHM) providers are increasingly providing delivery room (DR) coverage for high-risk deliveries. Most have little post-residency DR training, and there is evidence that DR competencies are not being achieved through traditional residency programs. Given the wide range of DR and nursery services at different community hospitals, it is unclear what level of training is appropriate to prepare for attending deliveries in a community hospital. Objective: To determine the demographic characteristics of neonatal deliveries including (1) providers, (2) infant gestational age (GA), and (3) delivery attendance vs. delivery resuscitation. Design/Methods: Billing data from 10/2016-12/2017 were used to identify neonatal delivery attendance and resuscitation. Demographic characteristics were identified through single-provider chart review of the delivery notes. The DR coverage model at our single-site community hospital includes neonatology (NN) coverage Monday-Friday 8A-5P, and PHM and moonlighters (ML) covering evenings, weekends and holidays. NNs are on-call from home for high risk deliveries when not onsite, and provide DR simulation for PHM providers at frequent intervals. Results: A pediatric provider (PHM, NN, ML, or PHMF) were called for 36.8% of all deliveries (n=1046/2846). PHM attended the majority of deliveries and resuscitations, followed by NN, ML (with variable experience), and PHM fellows (PHMF) with neonatal supervision (see table). NN providers attend a higher percentage of deliveries at 36 weeks GA (n=96/118). Conclusion(s): This single center study revealed that most deliveries and resuscitations are for full-term infants, and are attended by PHM, not NN. These findings suggest the need for achievement, maintenance and evaluation of DR competency. The mandatory DR training experience for PHM fellowships may offer an opportunity for PHM to lead this effort for trainees, but does not address providers already in practice. Future research efforts to develop evaluation systems and outcome measures for DR competency are needed.