Pregnant patients in the ED

  1. Please send me your hospital policy on when an OB patient goes to OB and when they stay in ED. Our policy is 20+ weeks with ANY abdominal complaint that could be labor/complication of preg. goes to OB. (Obviously trauma abdominal complaints get treated in ED first). Now our hospital wants the ED to "screen" all OB's then send to OB if warranted. WE almost had a catastrope last week when a 37 weeker presented with back pain. OB finally accepted and noted late decels and went for STAT c-section. We do not have TOCO in ED, can only monitor fetal heart tones by stethoscope doppler.

    Thanks in advance for all who help.
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  2. 28 Comments

  3. by   acuteobrn
    ok i will venture to answer your question.

    mind you i am a new graduate RN and don't have the entire pollicy in front of me so here goes...

    20 wks and less are handled down in ER and can be transfered to OB for special reasons ie., 18 wk IUFD for induction etc.

    over 20 wks and if:

    Trauma handled in ER trauma surgeon, OB/GYN must respond in <30 min. OB RN and hospitalist immediate responce. can go in diff directions from there and if immediate delivery is necessary and mom is hemodynamically stable C/S in L/D if not main OR.

    Emergent same as above w/o trauma surgeon and direct up to L/D once medically cleared ie., minor MVA with c-spine clearance, fall, severe vomiting (could also be a sign of impending delivery)

    ANY s/s of PIH, siezure, impending del. SROM or any other OB emergency auto direct to L/D no stop at triage even if brought by ambulance, s/b accompanied by ether ER or OB RN. and of course obvious non emergent r/o labor, srom and decreased fetal movement are directed straight to L/D no ER triage necessary.

    NOTE there is fetal monitoring capabiities in the ER with hookup so that they can be tele monitored in OB and OB RN does OB assessment and such until medically cleared and able to be transfered to L/D for further monitoring (usally 6 hours s/p abd fall, MVA longer of course if necessary) ALSO the attending OB or OB oncall must be notified of pregnant patient once triaged in all cases that present and are seen initially in the ER. 30 minute time limit.

    this hospital uses OB hospitalists and/or 4th year resident moonlighters as resource usefull in r/o OB as cause of s/s and when to skip the whole ER trip all to gether ie., pt 30 wks with severe epigastric pain needs to be r/o HELLP and/or severe PIH.

    this is a Level II+ OB/ER.

    hope this info helps
  4. by   canoehead
    20 weeks or more goes upstairs unless it's an obvious nonOB complaint like an earache. Traumas stay downstairs to be stabilized, bandaged, etc, then go up for admission. Traumas that are unstable for more than 5 minutes go up immediately or are transferred out on the next bus.
  5. by   SteelTownRN
    We have OB triage upstairs on the OB floor. When anyone who is pregnant presents, they are seen and triaged upstairs, right where they should be. It works out well. We have 8 beds in the tirage area, with tocos, and a c-section suite right across the hall.
  6. by   KaroSnowQueen
    I don't know our policy, but I do know my daughter in law went to the ER with abd pain in her 19th week and the ER doc decided to break her water and induce her since he said it was "inevitable" that the baby would be lost. This was not the case, although after he got done there was nothing else to do. The OB was incensed that she was not sent to OB instead of them handling it.
    And yes, the baby died two days later.
    I think it depends on if your ER docs have sense or not.
  7. by   RNCENCCRNNREMTP
    Originally posted by KaroSnowQueen
    I don't know our policy, but I do know my daughter in law went to the ER with abd pain in her 19th week and the ER doc decided to break her water and induce her since he said it was "inevitable" that the baby would be lost.
    WHAAAAAAAAAAAT??????????????

    What kind of a retard doctor saw her??????????

    I would be contacting:
    The hospital
    The state medical board
    An attorney

    STAT!
  8. by   KaroSnowQueen
    A stupid doctor that's what kind. I have contacted the hospital. Trying to get the kids to sue but they haven't got past the baby being gone yet. It was wrong, it was bungled, it was inexcusable, and if I say anymore I'll cry.
  9. by   Tink RN
    The policy at our hospital is 24 weeks IF the patient presents to the ER with any OB/GYN complaint - they go directly to LDRP. Ofcourse in a trauma situation the patient is stabilized in the ER. We have an OB monitor in one of our trauma rooms that also is displayed on the monitor at the nurses station in LDRP. (I don't know about you guys, but I am certainly not comfortable with monitoring those solo - I've never worked in OB!)

    I'm surprised your ER physicians are OK that. Sounds like a lawsuit waiting to happen to me!
  10. by   MtnMan
    Used to be 14 weeks and recently changed to 20.
  11. by   Scis
    20 weeks and up for any gyn complaining of anything remotely related to the pregnancy. Remember, most people are off on the weeks anyway, when in doubt, send them up. L&D is great for screening and attempting to send them back down if they get a softy on the ER line when they call back down to us. Of course if the patient presents with acute asthma and is pregnant, we stabilize first then send up for evaluation in L&D.
    I have a good one for you that happened recently. A veteran ER triage nurse sent a 36 weeker up to L&D because she was complaining of a large abcess to her external vaginal area. No way we were touching that one with a 10 foot pole! A new ER RN accepted the patient back down from L&D because they told her they could not excise and drain the cyst in their area because they would "contaminate the floor"...translation, they knew the odor that would emit from the golfball-sized cyst would be unbearable and they didn't want to deal with it. Rather contaminate the ER, I suppose, since we are thought of as "contaminated" anyway! Nice, huh?
  12. by   Godswill
    I don't know our policy, but I do know my daughter in law went to the ER with abd pain in her 19th week and the ER doc decided to break her water and induce her since he said it was "inevitable" that the baby would be lost.
    !
    This has got to be the most horrible thing i have heared in weeks, What an idiot this dr was i would sue his butt so baaad, he would not know what hit him. How horrible for a dr. to say or do such a thing when he could at least try to prolong her pregnancy so the baby have a better chance, of surival. I can not believ HE BROKE HER WATER
  13. by   mommatrauma
    20 or more weeks..regardless of complaint with the exception of trauma...they go to OB...Trauma's we stabalize and clear first then they go to OB..If the trauma has abd issues, or is too unstable to go right to L and D...OB nurses come over and monitor baby while we monitor mom...
  14. by   Peg804
    20 weeks they go up to ob for assessment and monitoring. Do you know how lont it has been since the ED doc delivered. they want nothing to do with them, unless it is obvious that it is not OB related- fx, etc. anything else goes to ob and then can come back to the ed it he see fit, I have not assisted in a delivery in eon :chuckle

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