Need ideas for an old problem!

[rnaturcervix]

How does your facility handle OB pts that come in through the ER( as far as how they get to L&D)? This has been an ongoing struggle for the 15 years I have worked at my hospital. We've tried many different approaches. The L&D staff had educational meetings with ER(per their request) to inform them on which pts were safe to walk up on their own, which ones they could safely send up with a tech or transporter, and which ones they needed to bed and have us come down to assess. Due to a recent ER doc's cockiness, we now are required to pick up 100% of our pts from the ER. This doc performed a SVE on a screaming, bearing down pt, said she was closed, and sent her up with a tech. The screams arrived long before we saw the pt! We got her in the bed, pulled her pants down, and counted all 10 toes on her double footling breech! Thankfully, mom and baby were fine. We do not have techs, transporters, or CNA's on our unit. Most of the time we are understaffed, and I really don't think it's fair or safe for me to burden a co-worker with the task of watching my 8cm pt so I can go pick up someone complaining of mucus discharge. There has to be a better way! I realize ER is just as crazy and understaffed as we are. I'm looking for suggestions that would help both departments as well as account for pt safety. Thanks so much for taking the time to read this!

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[ChristineN, BSN, RN]

If a pt presents in active labor, why are they messing around with the pt in the ER at all??? My hospital has a policy, pregnant woman presenting to the ER with pregnancy related symptoms (ie bleeding, abd pain) after 20 weeks goes straight up to L&D without being seen in ER, as well as any pt in labor. These pts are always escorted up to L&D by either a tech or ER RN, whoever we have available.

If the pt is over 20 weeks and comes in with non-pregnancy related symptoms (ie pain post car accident) we will first clear the mom in ER, and then send her up to L&D

[rnaturcervix]

That's exactly how our's is supposed to be. The only exception is those pts acting like they will deliver in the hallway before they get to L&D. In these cases, L&D runs to the ER to deliver the baby, and then we take mom and baby back with us. I have no problem running down there for precip deliveries. Questions have been raised as to why the ER docs don't deliver the baby, but the reality is that most of them are not comfortable in doing so. I get it.... I really do. My complaint is that because of one failed attempt at assessing cervical dilation(pretty big fail), ER staff are not allowed to bring pts to us. A L&D RN must go get every pt. I just wanted to get a feel for other facility protocols. Thanks for your response.

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[lovemyjoblandd]

The policy at my hospital is exactly the same as ChristineN's. The only time a pregnant patient over 20 weeks does not immediately come up to L&D is if there are other life threatening situations to the mom or if it is completely unrelated to the pregnancy (ie a broken toe). If that is the case then a L&D nurse will go down and assess heart tones in the ED. The only patient's that walk up to our unit are those scheduled for induction or C/S and those coming for a NST. Other than that, every patient is either wheelchaired up by a transporter or brought up on a stretcher with a RN and transporter. We play clinic so much at night that if we had to go get a patient from the ED everytime, we'd never actually get to be a nurse.