OB pataients in the ER

grammyr · Apr 25, 2006

The nearest hospital with OB is about 30 minutes away from our facility. If a patient comes in who is in active labor, we deliver and ship. If she isn't in active labor we call her OB and ship. Either way, they are out of there ASAP!!!

mom23RN · Apr 25, 2006

Thankfully we had an OB dept. at our facility. It even had it's own EMS dropoff!!!! :lol2:

Our norm was no babies delivered in our ER unless it was a precipitous delivery in the parking lot!!! Other than that we ran them screaming up to L&D.!! :lol2:

Medic/Nurse, BSN, RN · Apr 25, 2006

preggo patients follow these rules.

prehospital

* over 20 weeks. calm the mom (care will focus on mom and babe)good assessment/history, lots o2, pick her up to stretcher (as opposed to letting her walk any) enroute to ob service or tertiary care. iv access in the truck. work on correction of problems identified.

* under 20 weeks (care will focus on mom), the local ed owns this one. o2, transport, iv-do problem focused assessment with emphasis on correction of problems found.

hospital

the under/over rule apples here to: less 20 weeks, the ed service keeps the patient with consult to ob/gyn if necessary.

over 20 weeks, we are looking to get this patient to an ob service without delay (either in the facility, sister facility or even a helicopter ride to an ob/neonate center). of course, we treat the mother and provide any needed intervention.

key points-the ed is not the best place to deliver for so many reasons. we can and do deliver babies in the ed, but i prefer that the stork fly mach 3 to get to ob land!!!

mhull · Apr 25, 2006

Just wondering how all of you manage OB patients in your ER when they present with complaints related to their pregnancy or in labor? Our hospital recently moved all OB services to our other campus which is a 10-15 min drive across town and we are having some issues with what to do with these patients when they present to our ER.

Where I work it is similar to NREMT-P/RN's. If over 20 weeks they go to OB unless the deliever in the lobby, parking lot, or don't know they are pregnant and come in then deliever in the room. We have had that several times. If under 20 weeks we keep them and call OB doc if needed.

brianaerrn · Apr 25, 2006

To those of you with no OB dept in house- Do you simply ship the pt without evaluating first if she is in active labor over 20 weeks? Are your ER nurses trained in OB- ie fetal monitoring and cervical exams? Right now our policy is that if an OB pt presents over 20 weeks, we call a L&D nurse from our other campus to evaluate and contact the pts OB physician or the OB on call if no prenatal care. Our ER doctors do not and refuse to see these patients. This weekend we had a 27 week OB patient present in active labor with no prenatal care. Had to sit with this patient for 40 min not knowing if she was going to deliver or not- very scary.

SueBee RN-BSN · Apr 25, 2006

From reading the OB posts, it seems that OB patients get poor, unprofessional care. Are there fetal monitors in your ER? Why run screeming to L&D? What if an OB patient needs a c-section, and there is no OB services at the hospital? Are there infant warmers, and someone who can provide NRP to the newborn?

jenn_rn_nj · Apr 25, 2006

the facility at which i work uses a 16 week guideline. if

if >16 weeks, then the patient is taken directly upstairs to OB regardless of the reason for the visit. our ED does not have fetal monitors; we do have infant warmers but only because it is a pediatric ED.

brianaerrn · Apr 25, 2006

We do have fetal monitors and warmers but are "forbidden" to hook up the patient to the fetal monitors before the L&D nurse is there. The hospital has refused to provide us training in OB because they states this creates too much of a liability. Sometimes it takes 30-40 min for the L&D nurse to arrive. This makes me very uncomfortable.

SueBee RN-BSN · Apr 25, 2006

We do have fetal monitors and warmers but are "forbidden" to hook up the patient to the fetal monitors before the L&D nurse is there. The hospital has refused to provide us training in OB because they states this creates too much of a liability. Sometimes it takes 30-40 min for the L&D nurse to arrive. This makes me very uncomfortable.

Education and training a liability? In 30-40 min the patient might as well be transfered to L&D.

You know, too many places that nurses practice believe more training increases liability. That is another example of dumbing down nursing.

I have to wonder if a study has been done on this topic?

Jolie, BSN · Apr 25, 2006

To those of you with no OB dept in house- Do you simply ship the pt without evaluating first if she is in active labor over 20 weeks? Are your ER nurses trained in OB- ie fetal monitoring and cervical exams? Right now our policy is that if an OB pt presents over 20 weeks, we call a L&D nurse from our other campus to evaluate and contact the pts OB physician or the OB on call if no prenatal care. Our ER doctors do not and refuse to see these patients. This weekend we had a 27 week OB patient present in active labor with no prenatal care. Had to sit with this patient for 40 min not knowing if she was going to deliver or not- very scary.

EMTALA requires you to assess a patient in labor prior to transport, and prohibits transporting a patient who can not reasonably be expected to arrive safely at another facility prior to delivering.

I don't begin to understand how an ER doc can refuse to see any patient who walks in the door, pregnant or not. Besides being unethical and unsafe, it seems like it must be an EMTALA violation as well.

Relying on an OB nurse who may not arrive for 20-30 minutes is absurd, and will eventually land your facility in a well-deserved lawsuit.

I would go to risk management and demand that there be a nurse scheduled somewhere in the facility 24/7 who is competent in OB to be immediately available to manage ER OB patients.

Jolie, BSN · Apr 25, 2006

We do have fetal monitors and warmers but are "forbidden" to hook up the patient to the fetal monitors before the L&D nurse is there. The hospital has refused to provide us training in OB because they states this creates too much of a liability. Sometimes it takes 30-40 min for the L&D nurse to arrive. This makes me very uncomfortable.

Do you also refuse to provide appropriate treatment to MI patients because no cardiologist is present? Do stroke patients get neglected until a neurologist arrives? Are kids ignored until a pediatrician is located?

You can see where I'm going with this. Please do not take my rant personally. My anger is directed at the bone-headed administrators who came up with this twisted logic that it is better to ignore a patient than treat her because she is pregnant.

Unbelievable!