ED sending patients to L&D

  1. At what gestational age does the average Emergency Department (ED) send a mom to L&D?

    Does the ED always stick to hospital protocal?
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  2. 23 Comments

  3. by   SmilingBluEyes
    Where I am the cutoff is 20 weeks, UNLESS it's a stillbirth or inevitible loss that needs to be handled on the OB unit. Then, we have seen them anytime after 12 on our unit for appropriate treatment. It really depends on the individual case. But 20 weeks is generally the cutoff.
  4. by   ElvishDNP
    20 weeks here.

    We also deliver <20 weeks on the postpartum/GYN floor, not in L/D. I don't like it but that's hospital policy.

    We have been burned before; ED will call report and say the pt is 19weeks; she gets to the floor and we review the chart to find out that she is really 24weeks, by dates and u/s. The error may not be intentional, but 5 weeks is a big difference.
  5. by   cassioo
    Ours is about the same the book says 20 weeks to L&D but sometimes when you get the wheel out they aren't quite 20 AND I've had a smartass ER nurse (who'd I'd had in clinical group the year before and he was a smart ass student) call and say they were sending over an 18 weeker and when told she wouldn't go to labor his response was when I wheel her out she'll be 20..guess he was going to change the dates. If they are pregnant at all no matter what the complaint they will come to our PP/GYN floor....we had an AB the other day who had just missed her period 5 weeks before so had a positive pregnancy test...if it would have been 10 years ago she'd have not even known she was pregnant and think it was a heavy period.
  6. by   smithsu
    If they even mention their pregnant in our ED they send them to us. They have sent patients that we found weren't even pregnant.
  7. by   cassioo
    Quote from smithsu
    If they even mention their pregnant in our ED they send them to us. They have sent patients that we found weren't even pregnant.
    we get those also we had one this summer screaming with contractions, no prenantal care (big girl) she screamed and pushed and pooped all over the bed. the nurse that checked her found nothing sent her for sono for dates and she wasn't pregnant.....notified security in case she was looking to take a baby...she had an 11 mo old we'd delivered.

    We also had a Spanish speaking woman the came running with that was crowning because she was small and all her husband could say was her stomach hurt so she sat in the ER waiting room for 5 hours. I speak just a little Spanish and got out of her what I thought was a due date which made her 28 weeks but when the baby came out screaming but small (5 lbs) the date she'd said was when she had seen a doctor last so she was term.
  8. by   babyktchr
    Oh, the age old thorn between the ED and L&D. We have a policy for >20 weeks BUT it can be overridden by the ED doc is he feels her fundal height is higher (uh huh). There is always something being sent up that is inappropriate. We had a call recently from the triage nurse saying she had a 20 week pregnant woman down there with chest pain and shortness of breath, should she send her up to us? I said...why don't you rule out that MI or PE first and then you can send her up and we can listen to the baby. Or the MVA with injuries that they want to try to bring right up to us to evaluate baby status, before mom status is even determined. It is quite frustrating.
  9. by   rnmomtobe2010
    where i am from, 20 weeks.
  10. by   Mrs.S
    We had a pregnant lady not too long ago come up from ER who, when we started getting her OB history, was like, "Um, I just sprained my ankle..." Got a quick NST and sent her right back down to ER. Now really...
    Anybody pregnant comes up to L&D at our hospital; there is no cutoff.
  11. by   cassioo
    Had a lady come in yesterday through the ER when they called her over I asked what her complaint was... "she wants to be checked she's had a few cramps" MD's office was closed. She gets over to the unit and says her last baby (14 mos old) came quick (don't they all). She was 3 so doc said he'd keep her. Broke her water about 30 minutes later when she was 5 then 31 minutes later with 2 pushes she had her baby. Just goes to show about as soon as you get comfortable with the oh yea right it comes back to bite you in the a.. She had the baby faster then the paperwork was done wish they'd all do that really
  12. by   ragingmomster
    20 weeks here too.

    We don't take the ED's word for it though. As a teaching hospital, that's what we have interns for.

    Personally if I triage a pt who came in through the ED, before they go home I tell them "Don't go to the ED for your pregnancy unless you have been in a car accident, have broken your arm or think you are going to die. They don't want you there and we like to see you here, you keep us in business."

    Worst was a pt with a grossly fractured ankle who said she was pregnant when they started taking X-Rays. She was sent to us before the X-Rays were read. Um, hello? I know nothing about orthopedics but I know a toe should not point toward the opposite ankle!
  13. by   DEB52
    Well let's see how the rules are for us. In triage it is 12 wks. On my antepartum unit there is no age limit. We have had 9 weekers with hyperemesis or uncontroled diabetes. Vaginal bleeding is also a common one. Sometimes if the issue is not pregnancy related they will go to an medical floor where we go up twice a day to monitor the patient. But the physicans don't like that so most of the time they come to us.
    bugeyes:
    Last edit by DEB52 on Oct 7, '07 : Reason: correct spelling
  14. by   dawngloves
    Quote from Mrs.S
    We had a pregnant lady not too long ago come up from ER who, when we started getting her OB history, was like, "Um, I just sprained my ankle..." Got a quick NST and sent her right back down to ER. Now really...
    Anybody pregnant comes up to L&D at our hospital; there is no cutoff.

    I'll never forget when I broke my toe @ 32 weeks and they wanted to send me to L&D. I refused because it was asinine. I bumped my toe on a table! ER doc said it was OK for me to stay in the ER. Gee, thanks!

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