Why hospitals adopt the laborist model of obstetric care: A qualitative analysis

The practice of obstetrics is evolving to include more laborists staffing obstetric units. However, there is little data regarding individual hospitals’ reasons for adoption, the adoption process, and the perceived outcomes. In order to gain a better understanding of the rationale behind the adoption of the laborist model, role of the laborist, costs involved in the adoption, and perceived changes in patient care, we interviewed several leaders involved in the adoption process at their respective institutions. Eight National Perinatal Information Center /Quality Analytic Services (NPIC/QAS) hospitals that employ laborists consented to take part in a qualitative study on adoption of the laborist model. Representatives at seven of the eight NPIC/QAS member hospitals that had consented were interviewed over the phone. Four thematic areas emerged from the interviews: Model as Adopted; Adoption Process; Roles and Division of Labor; and Quality of Care. These themes elucidated the evolution of the laborist model within the hospitalist framework, the implementation of the model, and the perceived implications for patient safety. Six institutions indicated that the model was adopted primarily to improve patient safety, and five institutions noticed improved patient safety and satisfaction with fewer adverse events. Quantitative research is now needed to substantiate the claims of improved patient safety. Additionally, further evaluation of the different models is needed to understand the most optimal model for obstetric care delivery.