How does your facilty handle triage of OB pts?

JessicRN · Apr 29, 2006

Our Ed runs the latter we ask the name and how many weeks pregnant if we think the pt can't wait though we bring her into the ED or we go up to the floor with the pt. They sign nothing unless they come into the ED

Trauma Columnist · Apr 29, 2006

Our ER works like this: under 20 weeks, they are the ER's pt. Over 20 weeks they go upstairs to L&D - ER does not triage, nothing. However, the caveat for us is if the pregnant patient over 20 weeks comes in immobilized then they belong first to the ER than after treatment for their immediate needs, they go upstairs to be monitored. Pregnant trauma patients almost always have an OB resident come and visit them in the trauma room.

TraumaLPN · May 10, 2006

Our Ed policy is anything under 20 wks. stays in the ED, Over 20 wks. with c/o abd or back pain or elevated BP goes to L&D and of course trauma is evaluated first in ED. Recently L&D have decided that all pts' with ruptured membranes needs to be taked to L&D on a stretcher, and of course it was made policy. Most of them only urinated on theirselves but they get a stretcher ride!

Aneroo, LPN · May 11, 2006

It depends on what is going on.

Under 20 weeks, it's our initially (have seen some 18 weekers about to abort go to L&D).

Over 20 weeks, it depends. If you're tachycardic, or have a non-OB complaint, you are ours. We get FHT, then may do continuous fetal HR monitoring, which means a L&D nurse comes and sits with the patient.

If you come in via EMS or triage with an OB complaint, we have a template- Contractions? How far apart? Membranes ruptured? How far along/how many? And then ship them on (unless they're about to deliver right then).

TraumaLPN · May 11, 2006

HAHAHAHAHA!!!!!!! L&D come to the ER to moniter a pt? Our L&D nurses will refuse a pt. if they are 19 weeks and 6 days! It is a constant struggle at our ED.

TazziRN, RN · May 15, 2006

HAHAHAHAHA!!!!!!! L&D come to the ER to moniter a pt? Our L&D nurses will refuse a pt. if they are 19 weeks and 6 days! It is a constant struggle at our ED.

Our L&D nurses will come monitor a pt in the ER if OB is full, but that's the only way.

Our policy: 19w/6d stays in the ER unless the pt insists on going to OB. Doesn't happen often but does occasionally. Otherwise, 20w and over with anything between the crotch and the epigastrum, HA and HTN, go straight to OB.

I once had a pt come in who was 20w/?d by sono, but only 19w/?d by LMP. I sent her to OB. They sent her back. Then ensued a phone battle that I finally won when I slapped them upside the fetal monitor with the sono results. 3 or 4 freakin' days, good grief!!!!

BillEDRN · May 31, 2006

I have been having some discussions with our management regarding this very issue, so I would appreciate any feedback on the following concerns I have with the system.

During the day, L&D patients go directly to admissions and then to L&D. During the evening, when admissions is closed, they come to the ED as it is the "only open door." Our triage nurse is supposed to evaluate the patient's complaints, using the "script" developed the admissions clerk, and based on those answers, either send the patient upstairs to L&D or into the ED for evaluation. My concerns are:

First, the nurse is using a "script" developed for the admission clerk, not standard nursing assessment criteria. Notably absent is a check for cervical dilatation. Aren't we as professionals held to a higher standard than a layperson in assessing the patient?

Second, we do not document any assessment, not even the patient's response to the "scripted" questions. If there is an adverse event as the patient is transported up to L&D, how do we defend our actions? Especially since legal actions sometimes do not manifest themselves for several years.

I find our management's lack of concern for the possible legal ramifications of these practices distressing. It is interesting to note that we are "encouraged" to check the patients we are "unsure" of into the ED so the ED doc can check them out before sending them to L&D. Ironically, our docs won't see the patient unless a chart is generated (documentation purposes) and the patient is placed in a room for a physical exam that consists mainly of a pelvic/cervical exam. (standard of care)

Oh, and just so you know, my concerns are based on my personal experience while taking one of those patients who answered the script "correctly" to allow her to go directly up to L&D. While in the elevator, she delivered with a nucal cord. Had I not been there (they are normally transported via NA or transporter service, I just happened to be free to transport her that day) to facilatate the delivery and remove the cord, the infant would have certainly had some degree of anoxia and possibley severe lifelong problems.

TazziRN, RN · Jun 4, 2006

i would rather have the policy that we do: where the mom goes depends on fetal age and mom's complaint. better to be safe and have ob check her out and send her back than have it be something ob and she's still in the er.

luckylucyrn · Jun 6, 2006

Where I work, our L&D is in a separate hospital (but on the same campus), and we can't turn away any pt due to EMTALA, not even to tell them to go to the Women's hospital. If they ask, we can then and only then tell them. So what does this equal? Several babies born in the ED. And lots and lots of 1/2 mile ambulance rides to the other hospital.

rjflyn, ASN, RN · Jun 7, 2006

We have the OB at another campus situation here as well. So everything gets evaluated here. Generally if the moms life is not endanger and delivery imminate, and not involving trauma ie MVC, anything 20+ wks goes to the other site via ambulance. We do ultrasound most of them first as we share the tech and she is here unless called to the other place. And yes 19 6/7 weekers stay, with the ultrasound measurements taking priority.