ER triage protocols for OB patients

Specialties Emergency

Published

Does any one have triage protocols specifically for OB patients who present to the ER with non obstetrical complaints they would be willing to share with me? Thanks:typing

RedSox33RN

1,483 Posts

Specializes in Emergency Dept, M/S.

In our ED (well, my old one, since I just left and moved back to New England!), they would be seen for the chief complaint, but we would always assess fetal heart tones and chart them. If the pt was over 20 weeks, no matter what the chief complaint, they had to be transferred via w/c to the L&D floor after they were cleared/dc'd in the ED and be seen in L&D triage. The only change from this protocol was if we called L&D and the attending OB gave orders over the phone that the pt did not need to be seen, after we gave report. This happened a few times to me when L&D was over-flowing, and the OB pt was less than 36 weeks and only seen in the ED for a sprain, cold/flu sx, etc.

I did have one though that I sent up anyway, even after the OB attending said she didn't need to go up. She was 36-37 weeks, presented with excessive vomiting and fever - some stomach virus that her young son had also had. Fetal heart tones were fine (couldn't assess ctxns since we didn't have a full fetal monitor, but pt denied any), cervix was closed and thick on exam, but she also had +leukocytes in urine. We got the vomiting and fever under control, but I was thinking she just was not right and I didn't want to send her home, even though she was d/c'd by our ED doc and OB with a script for Phenergan and abx for a UTI. I mentioned my concern to the ED doc, but he wasn't too concerned. I called L&D triage and said I was sending her up anyway. They said they'd put her on the monitor up there.

So, she was having ctxn's she couldn't feel, probably from the UTI (I had the same thing happen to me in my first pregnancy, and it's hard to tell the ctxns from the bladder pain). Once she slept off the IV phenergan we had given her, she said she had kidney pain also, which maybe had been masked by the vomiting/abd pain. She had a kidney infection, and was contracting every 7-8 minutes pretty regularly. Ended up being admitted.

I'd be interested in every one else's protocols also. I'm going to be starting at a new ED in a couple weeks (just deciding on whether to stay with adult ED or try Peds ED. I'm job shadowing this week in the Peds ED to see if I like it!) so will be getting used to alllll new protocols! I've already learned this new hospital is way different than what I'm used to.

DaretoDreamRN

105 Posts

Specializes in here and there.

Well in my ED, the patient has to be having contractions and or/ lady partsl bleed and over 21 weeks??? to be sent to OB. We see 6 month pregnant mothers with SOB and they stay in the ED to be evaulated for various things e.g PE. We take care of 33 weeks pregnant females with hyperemesis in the ED. We still do the fetal heart tones and an Ultrasound. The only time they are sent to the OB floor after being evaluated in the ED is if the patients OBGYN requested it or the ED physician believes they should go to the OB unit.

kmoonshine, RN

346 Posts

Specializes in Emergency.

20+ weeks - up to L&D. If they had trauma (ie car accident), they must be cleared in the ED first. Also, if their condition is life threatening (ie severe asthma), they stay in the ED. But for generalized flu/headache/nausea etc, they go to L&D.

I had one lady come into our ED ambulatory and 32 wks preg, stated she had some lower abd. discomfort and mentioned she hurt her ankle a few days earlier (no fall, no other symptoms). L&D refused to accept her until we cleared her. No deformity, no swelling. I wasn't happy about that and got the charge nurse involved, because she would have had to wait in the waiting room because there wasn't any ED rooms open (but they had open beds in L&D). You never know what you'll be exposed to in the waiting room, and I hate putting preg patients next to all that sickness. So, I send up to L&D as much as I can - that way they can get the specialized care they need, make sure baby is ok, and promote teaching.

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