er vs. ob the battle goes on sort of

[imenid37]

i truly don't know how to make this short, but i'll try.

i work in ob in a small community hospital. we are a level one facility w/ no ob dr. in house after hours. if we need the dr we call him or her at night and they come in. if it's a big problem, they are almost always very good about coming in.

we triage or should i say we did for things like r/o labour, ptl ,uti's, etc. for awhile, we like most other similar units were getting pt's from the er w/things like "i have bronchitis, but i am six months pregnant." so up to ob they go. we even got a spanish speaker who was thought to be pregnant (because she had a round belly) and looked to be in pain. turned out she was 10 weeks w/ constipation. this went on for years as it does in many hospitals and yes it was irritating.

Now our er triages pregnant pt's unless they are at term and appear to be in labour. this is very troubling to me. no, i don't want to see your broken arm if you are six months pregnant and otherwise o.k., but this weekend was a real eye-opener to me. they had not let our staff in on the policy change yet, but the er knew about it.

i get a call from the er about a lady 25 weeks w/ cramping and bleeding. they are asking if the ob dr. happens to be in the house. no he is not. o.k. we'll see her and then maybe we'll send her up to you. her ob physician comes to our hospital,btw. huh? to me she needs efm and a ve. maybe she's in ptl. hard to evaluate w/o monitoring and ve unles dr. (hahaha) or er nurse (she's got all the time in the world right?) is gonna stand there and palpate uc's. i thought this was totally bizarre that they were keeping this pt., but i offerrred to send down the prenatals, but they didn't think they needed them. (in mean time i called ob dr. on call who informs me this is the NEW policy, but he is not as angry w/ me as he could've been considering i woke him up at 00:30)so they keep her for about 30-45 min. and send her to be monitored. bleeding is very miniscule and occurred a few days ago and has mostly resolved. they did spec exam and cervix was closed. she c/o cramping, but i don't see and can't palpate uc's. i po hydrate her. they get better, but she still feels a little lower abd. crampiness. so i call er and ask to send clean caught uac on the off chance she has a uti. well why? i was just told to monitor her. that's all. why do i think i have to do anything else for her. (not that the er dr. interprets the strip. ob dr looks at it the next a.m.) then i go through the whole explanation of how and why a uti could cause these sx's. why is er dr. tx'ing pt. if he doesn't know uti could cause this? scary to me.

next pt. is a very young young girl in the early third trimester w/bleeding and cramping after intercourse. they triage her too. she is losing her baby. spec. exam shows bulging membranes. we get her. she delivers for ob dr. ob dr. was called by er (nice for us) and arrives just after we get pt.

is anyone else doing this now too? am i way off to think if they have a pregnancy problem we should be seeing them. this is what we do after all. this is our area of expertise. management says it has to do w/ new emtala rules. please share your thoughts...

[winewinn]

I delivered a stillborn (36 wks), and was actually given a choice between an OB floor or another floor as we were leaving the birthing suite. I don't know which type of nurse would have been assigned had I chosen a different floor, but I opted for the OB floor anyway. I was in a quieter, c/s area, and that was fine.

I just wanted to say that it was a nice "administrative" move on the hospital's part in considering the emotional needs of the patient and giving the patient that choice during my stay. Probably not every hospital is always willing or really able to volunteer such an option. From a patient's perspective, though, it was a class act on the nurse's/hospital's part to give that choice, and the hospital really made me feel valued as a patient because of that consideration. They acted proactive rather than reactive to the circumstances. (I didn't think to request a different floor, but it was nice to have been offered.)

I think the OB floor was just fine, and I agree -- it's nice to have the nursing expertise from that area in such a situation. :) The nurses were super during my stay!

that would depend on the individual. We care for woman who have lost pregnancies often. Often Mother/baby nurses do this cause it's one of the things we are best trained to do, and in a more conducive environment, than, say, ED. We are trained in helping with the grieving process unique to parents losing their unborn babies or newborns. It's what we do.

But if a person absolutely refuses to go to OB, it's understood and respected. It seems many choose to come to our unit, anyhow.

[SmilingBluEyes]

I delivered a stillborn (36 wks), and was actually given a choice between an OB floor or another floor as we were leaving the birthing suite. I don't know which type of nurse would have been assigned had I chosen a different floor, but I opted for the OB floor anyway. I was in a quieter, c/s area, and that was fine.

I just wanted to say that it was a nice "administrative" move on the hospital's part in considering the emotional needs of the patient and giving the patient that choice during my stay. Probably not every hospital is always willing or really able to volunteer such an option. From a patient's perspective, though, it was a class act on the nurse's/hospital's part to give that choice, and the hospital really made me feel valued as a patient because of that consideration. They acted proactive rather than reactive to the circumstances. (I didn't think to request a different floor, but it was nice to have been offered.)

I think the OB floor was just fine, and I agree -- it's nice to have the nursing expertise from that area in such a situation. :) The nurses were super during my stay!

It was a great move. Where I work, our med-surg unit is way too busy and sometimes understaffed to deal with women who have experienced such losses, so most of the time they are better off on our unit. And fortunately, the way our unit is designed, they go to rooms (GYN/surgical) that are fairly far-removed from the LDRP suites and the nursery. There really is no "good" place to go when we have experienced pregnancy loss. Speaking from a patient's perspective myself (having had 5 first and 2nd trimester losses), I preferred the care I received on OB versus med-surg. It's individual, like I said. I was not given a choice and when I went to med-surg I was treated as a med-surg patient, not one who had experienced a painful loss of a pregnancy. Can't put everyone in the same box, I guess, is the lesson here.

[CA CoCoRN, RN]

wow! Any woman that walks thru our ER's door who is more than 20 weeks pregnant they don't even triage. Go straight to L&D, do not stop here.

Here here!! We do that Here here!!