OB in house

Sep 25, 2009 08:57 PM

by eandgsma

Hello all,

I'm curious...how many of your hospitals have an OB in house? How many deliveries do you have?

I ask because we do not and we have around 200 deliveries a month. It makes me uncomfortable that many times there is no OB in house for emergencies. An example...a G5P4 repeat c/s (this would be her 5th) came in with extreme abdominal pain, abdomen was hard, FHTs down and we immediately got things started for c/s but her OB was not in house and lives 30mins away. Thank goodness another OB from another group just happened to be there and got the baby out while the pts OB came in 45mins later. That girl had a complete abruption and had to have a hyst. She went to the ICU. What would we have done if the other OB wasnt there?

The argument I'm getting from hospital management is "who's going to pay for an OB in house?" My suggestion is to make the ER drop in OB stay in house, what's the difference? They can bill the OB to whom the pt goes to for their services if needed. That's exactly what happened in the above case.

So, what do you all do? Thanks!

miss81 · Sep 25, 2009, 09:55 PM

Re: OB in house

We don't have an OB in house, but they can be there within 15 min easy. Our GP's do vag. deliveries, they are not in house either. They are at home on call and can be there within 15 min too. However, I have delivered a few babies waiting for the doc to arrive. The routine on our unit is to call when the pt is fully or with any concerns.

shortstuff31117 · Sep 26, 2009, 02:47 PM

Re: OB in house

We do around 60 or so deliveries a month. The OBs are in their office next door from 9am to 5pm, Mon-Fri, otherwise they are supposed to be within 15 minutes of the hospital. When we have an emergency we just do what we can and hope for the best. That's all you can do. Fortunately emergencies don't come up too often.

HappyNurse2005 · Sep 27, 2009, 07:50 AM

Re: OB in house

We average 300 deliveries a month, and we have an OB/GYN residency, so the residents and their attending are always in house, 24 hours a day. thats 3 docs that are always there, at the minimum.

we have four other groups of physicians that deliver babies here, and they do not stay in house, usually. Some will, when they are on call. Some only come when they ahve a patient coming in. Some don't come until their patient wants an epidural (the attending is in house once pt has epidural). We've on occasion had to get doc from another group to deliver a baby/do an emergency section when the pt's primary doc isn't there yet.

Even with docs in house all day/night, I've caught a few babies that were faster than the doc coming down the hallway!

LDRNMOMMY · Sep 27, 2009, 10:50 AM

Re: OB in house

I work in a military hospital. There is always an OB in house.

babyktchr · Sep 27, 2009, 03:01 PM

Re: OB in house

Seems to me a 45 minute response time is a tad bit unreasonable. Certainly a facility can require your OB physicians to have a shorter response time. We do not have OB in house but they are required to live within a certain distance from the hospital. I would certainly bring this to the attention of your risk management department. There certainly would've been a different outcome if there had been no one there.

CEG · Sep 27, 2009, 08:40 PM

Re: OB in house

Where I used to work we did not have in-house OB. During the day most of our OBs worked in the adjoining building. At night they were anywhere from 15 min to an hour away. It was very dangerous. We once had a patient code during an epidural and we had no MDs in house other than the anesthesiologists. We paged every MD who delivers on the unit and one showed up about 15 minutes later. A rough day although mom and baby were okay...

I am always astounded by people saying homebirth is dangerous because it would take too long to get to the hospital in an emergency. If only they knew that help can be an hour plus away in the hospital they might change their thinking.

L&Dnurse13 · Sep 27, 2009, 11:36 PM

Re: OB in house

We do around 400 deliveries a month, although this month we are past 500. We have an attending in house always. We also have at least 1 midwife in house along with anesthesia on L&D 24/7. We are a high risk unit with a level 3 NICU. As fast as things can go wrong on L&D I am not sure I would be comfortable with no one being in house all the time. We have had c-sections called and baby out in 5 minutes from call time and still have to bag baby. Scary to think about waiting 45 minutes.

L&DbutterflyRN · Sep 28, 2009, 02:18 AM

Re: OB in house

I would also go to risk management about this. We do have about 400 deliveries per month. We have a 24/7 OB and anesthesiologist. We have used them plenty of times. For example when I had a cord prolapse pt.

**Elvish** · Sep 28, 2009, 10:43 AM

Re: OB in house

We are lucky to have residents and attending inhouse 24/7.

Not too long ago, though, we had a private patient hemorrhage post c/s and the OB was already out of the hospital. She'd missed a bleeder during the c/s and had to come back in and the pt had to go back to the OR. Big EBL on that one, way bigger than it would have been had she been in house. (And she didn't want the residents to come take a look at her....)

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OB in house

OB in house

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