OB Triage-wondering how other hopsitals compare to mine - page 2

At my hosital, all of our OB patients present to the ER, where they are assessed and then sent to us if further monitoring is required. Once we receive them, they are again assessed (fetal... Read More

  1. by   GailWHNP
    Wow . . . I can't imagine where you put all those ladies not in labor but who are waiting for a doc to wander and check them! We have absolutely no room to hold these ladies!

    At the 2 hospitals where I've worked, anyone under 20 wks stays in ER; anyone over 20 wks is immediately rushed to L&D (Er doesn't like any pregnant ladies sitting around). The RN assesses the pt and calls the MD with report for phone orders to d/c or admit the pt. We have an on-call OB (they rotate) who covers walk-ins. Women are seldom in our triage rooms for more than an hour, at most two hours.
    Gail
  2. by   HardDaysNight
    We have absolutely no room to hold these ladies
    Tell me about it. Its an ongoing frustration, and one that I don't think will ever change. My hospital too much into "this is the way we've always done it" mode.:angryfire
  3. by   mother/babyRN
    If ONLY our ER would assess our patients! Actually, anyone over 20 weeks who presents to the er usually ends up being assessed by us in delivery. Something about the ER being nervous around pregnant patients. They also try to turf people prior to 20 weeks up there also....
    If we have a patient in false labor or who is not progressing or doing much, we can also d/c with a doc order per phone. He or she doesn't have to see the pt though they often do. Since it is the night shift I am on, you know how that goes....They trust the nurses quite a lot on nights....We just call the doc, give report and they either send them home or administer theraputic rest if someone is a repeat offender overnight....We can and do also admit often prior to calling the doc for report and it isn't unusual to have the pt admitted and not call the doc until we need meds or an epidural....We love to let them sleep ( thats patients AND doctors)... We have quite a bit of nursing leeway and they know and trust us.....
  4. by   HardDaysNight
    I worked nights for about three years in a small hospital. I understand how it is for the doctors to give you a lot of "lead way". I've also seen a lot of nurses suffer because of it. You can't always read a doc's mind (which is what they expect you to do sometimes), and when you make the wrong decision, they don't always back you up. They will cover their ass before they'll cover yours. I'm definantly not saying that we have poor judgement as nurses......I'm just saying that you need to be careful with that because its your ass on the line when something happens.
  5. by   NRSKarenRN
    Per my understanding of this rule:

    If the patient is being assessed in a hold area and is NOT ADMITTED, she can be sent home , i.e. discharged without MD exam and just VO.

    If patient admitted or >23 hr stay (MC rule), needs to be assessed by doctor.

    Know thy policies AND state law...will protect behind every time.
  6. by   shay
    Originally posted by NRSKarenRN
    Per my understanding of this rule:

    If the patient is being assessed in a hold area and is NOT ADMITTED, she can be sent home , i.e. discharged without MD exam and just VO.

    If patient admitted or >23 hr stay (MC rule), needs to be assessed by doctor.

    Know thy policies AND state law...will protect behind every time.
    Aha!!! Okay, that clears it up for me. Our triage pts. are all classified as 'observation' and go home within a few hours. If they are gonna stay, we have to call admitting and change their status.

    Whew!! I've been practicing legally!!! :angel2:
  7. by   BugRN
    You're right! We also used the 23 hour "Observation stay pt" the doc's had that long to make up their mind before admitting them. It did get crazy sometimes when we also didn't have enough beds. I remember once needing to "kick out an NST" from her bed just in time to catch a baby! Crazy days, but God I do miss it!! kinda gets in your blood and Never leaves, once an L/D nurse.........
  8. by   Lawlee62
    This happened to us for awhile too after an incident occured. Nurses were no longer allowed to triage patients and send them home. After about 3 months of drs, pts and experienced nurses complaining, we all had to be "checked off" by senior nurses on staff and tested on things like Advanced fetal monitoring, VE's, etc. Then those who were checked off could d/c pt's again.
  9. by   debbiebuck
    :wavey: Hi everyone! I have been following ever so often and finally decided to jump in.
    I work for a small regional facility in the ER. I have read through some of your postings and would like to see what you guys think of this.
    At our hospital, if an OB presents less than 20 weeks she is assessed by the ER doc. If greater than 20 weeks, the ER nurse monitors the patient with EFHM and unless risks involved ( ruptures membranes, etc. ) she does a vag exam and calls the OB doc on-call to give report. Here, we have one RN per shift. ( It is a very small facility ) Some of the nurses are okay with this; some are not. One of the problems is- If you have an OB patient to come in, and then Mr. Smith comes in for chest pain who has had an MI and now is being transferred out, our OB patient is sitting there for maybe an hour with no observed monitoring by the nurse. We do have an option to call the floor Charge nurse, but if she is busy then this too causes another problem. It is almost like a ping pong game at times. ER nurse's patient/ Charge nurse patient. We do have OB on-call nurses, but the policy is that the patient must be in active labor before they are called. Can anyone give me documentation to help resolve this problem?

    Thanks!!!:uhoh21:
  10. by   SmilingBluEyes
    This would be a question best-asked of the ED/ER nursing forums, Debbie. But welcome to be OB/GYN and Midwifery forums!
  11. by   midwife2b
    Quote from HardDaysNight
    At my hosital, all of our OB patients present to the ER, where they are assessed and then sent to us if further monitoring is required. Once we receive them, they are again assessed (fetal monitoring and another admission assessment) and the doctor is notified of the results. However, if they are determined to be in false labor by the nurse, they cannot be discharged home until the physician sees them. Thus, they sometimes stay overnight just for braxton hicks contractions (which sucks for the patient!). In other hospitals where I've worked, we were able to discharge them with the doctor's phone order (for false labor). My hospital states that every other hospital is wrong and that it is an EMTALA issue. How do you guys do it at your hospital? I'd like to get feedback on my scope of practice as an L&D nurse and other hospitals' policies and procedures.

    HardDaysNight
    Our ability to send women home who are not in labor is written in our hospital bylaws. See how it is written in your hospital. The bylaws also give RN's certain "privledges" to do certain acts, such as deliver a baby in an emergency.
  12. by   midwife2b
    Quote from HardDaysNight
    I understand the ER part of it But what if the patient is actually admitted to the labor and delivery unit to be observed. Can I discharge them from the hospital even though the patient is not actually an ER patient?
    At my facility once the patient is transferred from the ED to L&D she is actually "discharged" from the ED; we then do the paperwork to get her an L&D account number and hence, she is no longer an ED patient.
    If she comes to the ER as a trauma pt. (MVC, domestic violence, etc.) she has to be cleared by the ER doc/trauma head in order to go to L&D. We follow the same rules as any other patient who comes in with a trauma; Their account number reflects a "trauma admission" and they can go to any unit without having all that ridiculous paperwork repeated.
    Complicated rules and regs...

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