OB pataients in the ER

[brianaerrn]

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.

[brianaerrn]

I too am angered with my hospitals response to this. Myself and several other nurses in the ER have requested training and the hospital has continued to refuse.

[nursejennie76]

Anything under 20 weeks stays in the ER no matter what the problem is. But over 20 weeks may also stay if there is no chance that the complaint is pregnancy related ( broken foot etc...) But had 2 cases recently where there was trouble getting the speculum in during the pelvic because a head was coming out, but they swore they were not pregnant!!!!! We pretty much ran to OB with those patients!!! I think a emergency delivery might be fun on a multi grava mom that has had prenatal care!!!!

[Pedi-ER-RN, RN]

Our OB's go to L&D if >20 wks.

[rjflyn, ASN, RN]

We have a like situation at my hospital. The campus with L&D is 5 mins down the street. Pregnant patients that just show up get evaluation per the ED physcians or on the 4 night a week she is there our ARNP- who works at the public health clinic as well. All the staff ER nurses are required to have NRP certification as well.

All patients that show up get evaluated. 20+weekers get sent to the other campus if stable. Less than 20wks depending on the complaint and fetal status- all patients with 100% certainty get ultrasound evaluation, go home or get transfered as well.

If an emergency c-section needs to occur our hospital is set up for it with the OR team from down the street comming over to do it.

rj

[MomNRN, BSN, RN]

Our ER policy is similar to those stated above. 20 weeks, they are evaluated in OB to determine if their complaint is related to potential delivery. If they are not a potential admit, they are sent back to ER for treatment.

The above being said, our OB department is just down the hallway - maybe 3 minutes away. Also, OB docs prefer their patients be treated in OB.

[Pedi-ER-RN, RN]

If they are not a potential admit, they are sent back to ER for treatment.

Thank God all of our pts>20 wks stay in L&D once they are over there, if they sent them back, we'd never get them all seen!

[JessicRN]

Over twenty weeks

-not major trauma up to our OB dept directly for assessment then down to us if baby checks out ok.(i.e assualt,fell,minor MVA no major injury)

-If trauma OB comes down and waits to do assessment in the ED. Mom is the priority baby second.

-If imminent delivery,we do not usually check unless mom says she feels like pushing or is screaming in pain, we check to see if crowning if not up to OB if so in to main ED, OB staff down to ED.

-Abd pain or laboring and no feeling like pushing directly up to OB.

Under 20 weeks to ED first in all instances

[mmcdon78]

I work at a level 1 trauma/burn ED with the luxury of an OB department on the 13th floor. If mom presents to Triage (or the ambulance ramp) crowning or hemmoraging she goes right to a Trauma bay. The NICU fellow and Labor and Delivery nurses will come to the ED to assist with birth. If they don't make it down in time, we have all of the necessary equipment to handle it until they get there.

If mom is in active labor but not crowning, she is brought up to the L&D floor by the ambulance crew accompanied by an RN. We keep an equipment box at Triage with bulb suction, cord clamps, etc. to take along just in case an elevator gets stuck... It's never happened but seems to ward off "having a baby in the elevator" spirits.

The equipment box also comes in handy when we proceed out to the ambulance ramp for a mom delivering in the back seat of a car.