Question for L&D RN's: Where to place patients?

  1. I've been put in charge of writing a policy regarding placement of patients when L&D, triage, and all beds are full. Just wondering if any of you have such policies and what you do in urgent cases.
    One small hospital nearby has stopped doing births, so we are incorporating an unexpected extra 25-35 women per month in our already crowded unit. Another small hospital will stop doing births October 1, so we are anticipating another 10-20/month then as well.
    One night last week, after moving everyone off the unit and doubling up who we could (antepartum and triage) we still had no room and... you guessed it... in came a woman who delivered outside the OR in a wheelchair while the night shift was scrambling to find a place for her to lie down. Everyone is OK but the doc (new to us) was livid that we didn't have some sort of emergency arrangement; where she came from patients stayed in the ER until it was safe to come up. We have policies about moving stable antepartum patients to the women's unit and PP floor but nothing about labor patients. I appreciate any input!
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    About midwife2b

    Joined: May '05; Posts: 263; Likes: 11

    10 Comments

  3. by   NurseforPreggers
    Usually when we have all beds full and a pt comes up we triage them in our OR recovery room. Its a room with 3 stretchers that is normally used for recovery after c-sections. This is usually a once in a while event for us however. It sounds like this might be something that you will be facing a lot with all the new patients you are expected to receive.
    We often run out of rooms because of the number of elective inductions that the doctors schedule for us. We have 11 labor rooms and most days have 5-6 elective inductions scheduled. If the docs would only schedule 2-4 inductions per day that would help relieve some of the pressure and keep a couple beds available. Fat chance in that happening though.
    Best of luck to you in solving your problem. I'm interested to see what suggestions other people may have.
  4. by   SmilingBluEyes
    This requires an IMMEDIATE aned URGENT meeting of administration, management and your perinatal committee! What are the DOCTORS proposing be done?

    Obviously, you have an untenable situation. Meantime, you may have to "turf" your postpartum patients to clean surgical bed on another unit besides women's services, or something.......using their (postpartum) rooms/beds for triage/labor patients, until you figure something better out. This is a matter of the utmost urgency. You have not stated what your management/admin are doing about it----I wonder really, what their plans are. Have they even TALKED to you about all this?

    Hopefully, something soon something is worked out, as flu season is just around the corner, and your hospital will probably fill up its census with sick patients at just the time you need beds! A lot of this has to be solved by people in more supervisory positions than nursing staff are in, unfortunately.

    How about your house supervisor? Are you working w/that person as cases come up to find empty beds? Just a suggestion....

    I am so sorry to see this happening to you....must be awful. I also feel sorry for all those patients; this is truly horrible for THEM.
    Last edit by SmilingBluEyes on Sep 4, '05
  5. by   babyktchr
    Boy, I only wish our ED would keep overflow labors. We run into this problem a lot now. We only have 6 LDRP rooms, 2 triage rooms and 6 other beds. We get the non OB patients moved if we can, but our hospital seems to be CODE MAX all of the time. We have had laboring patients in the doctors call room.

    The docs are going to be mad, no matter what the situation is. They only see their side only. Seems the louder you scream, the least you are heard. Hospital administration..they just don't seem to get it. L&D is as much an ED as the ED is. You just never know what is going to happen. It is an unsafe situation with no relief in site. I am interested to see is anyone does have a policy in place for this type of situation. I would love to have something to go to administration with when we are in that same situation.

    Laboring in the ER? Isn't that what they did on the tv show all of the time??
  6. by   SmilingBluEyes
    Most ED do NOT keep labor patients in their bays, for obvious reasons. I know ours won't. They have more urgent matters and needs for their beds---not to mention infection control issues that are hard to get around.
    Last edit by SmilingBluEyes on Sep 4, '05
  7. by   midwife2b
    Quote from SmilingBluEyes
    This requires an IMMEDIATE aned URGENT meeting of administration, management and your perinatal committee! What are the DOCTORS proposing be done?

    The meeting was held... and the docs want to know what other hospitals do; if they have a backup plan and what it entails... hence, my post... Obviously, you have an untenable situation. Meantime, you may have to "turf" your postpartum patients to clean surgical beds or something.......using their rooms/beds for triage/labor patients, until you figure something better out. Postpartum is on another floor. We only have pregnant patients here. We "turf" the stable antepartums to other beds but this particular night there was no room anywhere.

    This is a matter of the utmost urgency. You have not stated what your management/admin are doing about it----I wonder really, what their plans are. Have they even TALKED to you about all this? Yes, as stated above...

    How about your house supervisor? Are you working w/that person as cases come up to find empty beds? Just a suggestion.... It was the house supervisor who parked the wheelchair in front of the operating room... we have 3 OR's and 2 were running at the time, PACU was full... the OR table was the only horizontal space left on the unit (except for the leather couch in the nurses lounge) but she had to find a "real" labor nurse and that's how the birth happened the way it did...

    I am so sorry to see this happening to you....must be awful. I also feel sorry for all those patients; this is truly horrible for THEM.
    Yes, I know its not a great situation. I'm hoping for some good suggestions. Thanks!
  8. by   SmilingBluEyes
    Unfortunately, you will have nights like that --where all hell breaks loose---- and there Even those of us with more available beds and units that are more fortunately-equipped, have had horrible things happen like that wheelchair case---except our ED has us come and get them and if need be, deliver them on a bed in the ED.

    You said you want to know what other hospitals do----we deliver in ED if urgent enough----or--- divert when all our beds are indeed full and it is safe to do so..... It is very rare, but has happened. We all have bad times, Seems as if you are doing the best you can, day by day. Do you have ANY place to divert patients safely at all?

    I guess what has to happen is your ED and your unit will have to work something out. There has to be a place where a woman who is precipitously delivering can do so safely, whether it be in ED or someplace on L/D. I don't pretend to have all the answers. The suggestions I offered were the best ones I could think of off the top of my head. You situation is unique in that the "other hospital' has no L/D facilities to help you out....


    All I can say, is management, the supervisors and doctors need to figure this stuff out------keeping close, careful documentation and doing your best is all you have left at this point.....and...

    I am fresh outa ideas...

    And I am sorry, I am not sure what "good" suggestions would be, to you. I am just trying to think of ways to help as we go here.....

    I hope others come along that have more useful suggestions, really. Good luck.
    Last edit by SmilingBluEyes on Sep 4, '05
  9. by   SmilingBluEyes
    Also what occurs to me, is, if you truly are down to your last bed--- stable antepartums may have to go to PP/Mother-baby or another clean floor for a while---anyone on intermittent/periodic monitoring would be a primary candidate to move at least temporarily. When I worked in a hospital where the units were separate, we have had that happen on the rare occasion, as well. Not ideal, but a temporary fix that keeps a bed open for the case, such as the wheelchair patient you spoke of. May have to train some PP nurses to do stable antepartum care, as well.

    Desperate times, desperate measures. And cooperation between the units (ED, L/D, PP) is beyond critical at this point......

    Sorry I could not help more.
    Last edit by SmilingBluEyes on Sep 4, '05
  10. by   nancimarie
    We only have 5 birthing rooms and 3 other PP rooms for scheduled c/s and unscheduled also. We have to double up in some of our bigger rooms and use or antepartum room for NST. we don't have a triage room, our birthing rooms are used for that. We also don't have OR recovery rooms, they recover in their rooms or the ICU depending on staffing. We deliver about 400 a year, but have had a couple of busy months, 39 last month, that's a lot for us.
  11. by   SmilingBluEyes
    We triage in our LDRP's also. No triage rooms per se.
  12. by   SmilingBluEyes
    Any room in your ED for L/D triage??? Just wondering

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