Postponing inductions/sections when really busy?

Specialties Ob/Gyn

Published

Specializes in L & D.

I was wondering if any of your hospitals have a policy in place to use when your L & D unit is full. Do you have a protocol in place postpone non-emergent, scheduled inductions and/or c-sections?

The hospital where I work has been very busy lately. Laboring moms come in so fast we don't have rooms for them. This would be manageable if it weren't for the scheduled - often medically unecessary - inductions and sections. When we have a particularly busy day, I was thinking we should have a method to reschedule these patients. I know most MDs would never admit their procedures aren't medically necessary, and I realize that the hospital would never turn away a paying "customer", but days like this are unsafe!! The other large hospital in our area will divert patients to us, but we don't divert - ever.

Thanks!

Specializes in PICU/NICU.

The hospital where I worked did cancel elective inductions- just pushed them back 12 to 24 hours usually. Not so much the elective c/s due to booking the OR ect. Some of the moms got a little annoyed, but its better than delivering the the triage right?

BTW... I'm looking into Montessori school for my 2 kids, any way I could get your 2 cents? If you would PM me that would be great- thanks!

Specializes in L&D,Wound Care, SNC.

At the hospital I worked at in the states we did postpone inductions when we were busy. It was not without problems though. We had patients that thought if they caused enough of a scene they would get admitted. Some of the OB's would get very irate and verbally abusive to the charge nurses and our NM when we had to postpone inductions. They would come up to the floor and scrutinize the board and see how many nurses were on the floor that day. They would even go to the service line director, yeah like she can make rooms and nurses materialize out of thin air! :banghead: It was madness!

Specializes in Nurse Manager, Labor and Delivery.

We postpone inductions when we are full, try to bring them in the next day. We start with the more elective kind and them move our way down. We NEVER cancel scheduled c/s. NEVER. I dont' know why. When they come in for pre-op, I tell them THIS IS YOUR ROOM until we get another (a triage room) and they are ok with it, until they get back and there is no TV, not enough room and then they are ticked off. I have been in many a battle with prospective DADS when we have to post pone an induction. I love the "we had an appointment" line. I almost want to ask them if they guaranteed their reservation with a credit card? It is frustrating for EVERYONE involved.

Specializes in ER.

I can see why people would get upset when they are already there. Can you call them the night before if there is a possibility they will be cancelled?

Specializes in L&D,Wound Care, SNC.
I can see why people would get upset when they are already there. Can you call them the night before if there is a possibility they will be cancelled?

We certainly did try, but sometimes the numbers that the Dr's office give us are out of service or cell phones that do not accept incoming calls. Then sometimes the patients will cal the unit 1.5 hrs before their induction time. We have had days when we told patients to come in and between the phone call and the patients arrival on the unit we had several laboring patients that needed to be admitted first. It is very frustrating and I understand the patients frustration, but yelling and causing a scene is not going to make the situation change.

We postpone them as well. The majority of our inductions are elective, very few have medical indications (i.e. "postdates" induction 1 day post-EDD). So it is usually not a problem to postpone them. The patients usually seem to accept it pretty well. The doctors get mad about it but like PP have said, what do they want us to do? It's pretty rare that women come in laboring on their own and the majority are induced so it's not that common. More often than not a woman who comes in laboring has an "appointment" for the next couple of days anyway.

This same thing happened to me when I was pregnant with my first. Being induced for actual postdates (42 and 1). Got up at 5 am, called the hospital to double check and was told not to come. I was very irritated but got over it.

Specializes in Rural Health.

Our inductions are usually set for 5 a.m. so we can usually reach the patient by 1 or 2 a.m. if we just are positive we can't fit them in at 5. Occasionally if we miss them and they get up there before we get them called we ask them to come back in 2-3 hours but it doesn't happen often. *Most* take it OK as they are told by their OB docs that scheduled, non medically necessary inductions are the first to be rescheduled. For us it's not about having staff, it's about having SPACE. We only have 5 LDR rooms plus a triage room.

Specializes in LDRP.

We actually had an emergent section come in the other day that bumped our scheduled section and then our OR had to be closed down unexpectedly for terminal cleaning. So we sent one of our scheduled sections to the "regular" OR. That put everyone else there late, so we were doing scheduled sections until 10PM and had to do them after our OR opened back up as the other OR was full. IT was screwed up.

But yeah, we bump people. And they get pretty mad about it!!!!!!! I understand the anger/frustration, but patients have to realize we are a hospital and if an emergency comes along that takes precedence.

Specializes in OB L&D Mother/Baby.

I WISH that our unit manager was better at sticking up for the unit and postponing elective procedures but honestly it rarely happens for us. We are a smaller unit and only have three labor rooms so if there are two or three scheduled elective inductions then there isn't a lot of wiggle room for someone that comes in complete and or in actual labor, let alone someone that comes in for triage or any other random complaint.

There was a time when we had a electronic schedule board and it would "bump" elective procedures if we had too many but the docs complained and apparently our administration is more concerned with the docs being happy than the patients having a room and a monitor.

And yes even though they are obviously elective inductions there is almost always a "medical" reason documented... Like history of a big baby and the first kid was 8lbs, or high bp and the office bp is 112/60, or postdates and the edc is today... uggh. I'd rather have them write a "social induction" or STOP induction (sick and tired of being pregnant).

Specializes in OB.

We reschedule them if we are too busy. If we have someone in labor who is close to delivering, we may just put an induction on hold for a few hours, but the c-sections get rescheduled.

Our scheduled pts. are supposed to call at 5 am, but sometimes they dont, and it always seems to be those ones who get cancelled.

We had one couple come for an induction, without calling, and then get really mad when we said we couldnt admit her, they had all this stuff printed up with the babys birthday already! How stupid! What if it had been born earlier!

Specializes in OB/Neonatal, Med/Surg, Instructor.

We have a small department (5 LDRPs) and had to write a policy limiting elective/social inductions to 1 per day if the census permits. There are almost always hurt feelings and much whining (patient, patient's family, and HCP) when we have to and sometimes we don't get a lot of support from management or administration, it can be very frustrating. We usually try to talk with the patient ourselves and let them know how much better their stay will be when we aren't busting at the seams and assure them we will get them in asap. Some folks truly don't care what the reason, once they have been given a date and time then it's as if they have a contract of sorts they are trying to hold us to.....no patience at all. A lot of these same folks are quick to punt the baby to the nursery every chance they get.:confused:

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