Admission criteria

[IttyBittyBabyRN]

I work at a teaching hospital where usually we only have residents at night (unless by the grace of God we get an NP for a night) so as you can imagine it can be quite scary when you're stuck with someone who doesn't know their head from...well...you know. The other night (same as my last post) this idiot resident comes up from a delivery with a 224 gram fetus. Yes, 224grams. Exactly 8 oz. An abortion, I would think????? 14-15 weeks. She said it had a HR. It didn't when it got to us. Although it did "gasp" or something about 15 minutes later and got a HR of about 40 for a few minutes....very weird....Anyway, by her bringing it upstairs to us, we have to admit it--which is an enormous charge. We argued back and forth with L&D for at least an hour until they finally agreed to take it back (much cheaper for the family...who I'm sure won't be paying anyway....) What's your protocol for stuff like this? Granted we usually have to bring a lot of "really not viables" up b/c in the past residents have labeled some that when an hour later they were still gasping in the sink and had to be tubed, but this was ridiculous!!!

[IttyBittyBabyRN]

Guess I should have been more clear. We did not do anything for the 224 grammer. The issue was that the Dr. brought it up to our unit which requires us to go through the "admission" process thus creating a chart, charges, etc. I am convinced that med school is in no way preparing docs for the huge financial responsibility they must now consider in such situations.

As far as the gasping in the sink, I have heard many stories about years past that involved residents deciding at delivery that the babies weren't viable, then an hour later they're still hanging on. That led to the rule that anything with a heart rate should be brought to the unit.........back to the original issue.....shouldn't there be some level of common sense involved????? Shouldn't a third year resident have some grasp on the "big picture" and have known to wait a few minutes until the "abortion" ceased to beat??? It is so frustrating that these people are not smart enough to know when it's time to CALL THE NURSES AND ASK WHAT TO DO!!!!!!!!

[dawngloves, BSN, RN]

What do the L&D nurses do when they have a non viable deliveries? Aren't they supposed to keep the baby under the warmer or let the family hold it? They can tell the docs this too. (And I bet they do too, but some residents are such hammer heads don't get me started!)

[NicuGal, MSN, RN]

My other concern would be cost? What insurance company is going to pay for that admit? Probably none! We don't bring back kids like that.

God, that would stink to get a big bill for nothing! Bad enough they are paying for the delivery, but to pay for an NICU admit? I know mine would say no way!