Just when I think I've heard it all..... last night (I work in an ER) a woman came up to triage, full term, and having contractions, I called up to the L+D unit to give them a heads up and the nurse's response was "is she JUST in labor, or does she have cold sx. because if she does she can't come up here". I thought she was joking but she said no patients w/ cold sx could come to her unit. I asked her "so where does she have to go to give birth then?" (Which did not go over too well) and she replied "she goes to the Peds unit) She then demanded I take her temp. before sending her up.
I've worked in many ER's and have never heard of this policy. Am I missing something here or is this facility wrong?
Harry Krishna you can doubt ALL you like but the ER will send most minimally crampy 2 minutes pregnant people outrageously and ridiculously up to delivery and be gone before the wheelchair stops....And no, it is not unheard of to get the older people since many units are also OB GYN...I cannot begin to mention what inappropriate people the ER is quick to send upstairs KNOWING we don't see them before 20 weeks unless there is a pregnancy related issue....ALL THE TIME.......
And while mistakes will happen in both areas WHY can't the ER do a fetal heart??????Why does OB always have to come down to do one. Don't they have dopplers down there? I mean, I have to go through ACLS and a host of other stuff to take care of OB GYN patients...Can't the ER be taught to figure out where a fetal heart is and how to count it?????If there are other pregnancy related issues, the pt should just be sent up or brought up to OB....For a regular check, the ER should do it...
Same here. We got one the other week, who I swear, must have had a pos HPT that day! She came in for cramping. Well, hello, do you want us to put her on a monitor?
This week I had a 33 wker, that the ER calmy called up "She has PIH, can you come get her?" After being brought up in a WC by our support tech, I found out her pressure in ER was 255/184!!! Sometimes I wonder about the folks down in our ER.
I am not speaking of ALL ER nurses, just ours. Our ER does NOT triage OB pts, merely call up to the floor and say they are here come get them, so we don't get "report" from them. All pts are told to come through the ER unless they have called their doc and they've told them to come in. In this instance. if they checked the woman's pressure, they really should have relayed that in the message so a nurse could have gone down with the support tech. Luckily, this woman didn't seize in the elevator on the way up.
Sometimes we do have to wonder about them, when they call to say they are starting Mag Sulfate in the ER (totally inappropiate after they bolused an entire 500 cc bag into a pt), then they send us a 12 wker with a chest cold. Or insist we bring them a Doppler to check fht on an 8 wker. Don't worry. ER has plenty of stupid pt stories to share. Like the ones who come in by squad because they lost their mucous plug, or because it is their due date.:roll
i read your previous post, and correct me if i am wrong, but didn't the er nurse call and say the pt had PIH?
i think the responsibility falls on the ob rn who made the decision to only send a tech down to the er and not the staff in the er. also, the ob nurse should have asked what the vs were.
let's face it, that is why we all specialize in the field we are the most comfortable in. this way, it is a great check and balance system. so let's stop smashing pumpkins.
i recall that harry just asked for some opinions on policy, not to insult one another.
And while mistakes will happen in both areas WHY can't the ER do a fetal heart??????Why does OB always have to come down to do one. Don't they have dopplers down there? I mean, I have to go through ACLS and a host of other stuff to take care of OB GYN patients...Can't the ER be taught to figure out where a fetal heart is and how to count it?????If there are other pregnancy related issues, the pt should just be sent up or brought up to OB....For a regular check, the ER should do it...
do you work in a small county side hospital? we do fetal heart all of the time. i have also worked in several other er's and in every one of them we did our own fetal hearts.
i could not imagine calling a nurse to come to the er just for that! your hospital must be special. i do however remember being called from the er to start iv's on pts that a line could not be established by the ob rn. so we all help each other.
sorry that you have to hold the hands of your er rn's. maybe you can go teach them to count!:kiss
Specializes in NICU, L&D, OB, Home Health, Management.
I'll start out by saying I'm an OB nurse, but work in small hospitals where I have crosstrained to ER so, I have walked in both sets of shoes.
That said - it seems that some hospitals have a wonderful working relationship between OB and ER and some have awful relationships.
Instead of jumping all over each other, why don't we answer the question that was asked AND realize that if someone works in a place with a lot of animosity they are probably going to be fairly short tempered and defensive about this situation.
For those of you with a good OB/ER working relationship, you need to know that the other side is: 27weeker in a MVA with a compound fracture of R femur sent to OB "because she might be in labor". We only got her back to ER when the chief of OB came in and raised the roof. BTW - no indications of labor in ambulance - EMTs couldn't believe they were supposed to 'take her to OB'.(I was the RN on duty, so this is NOT an urban myth).
For those with a bad OB/ER relationship, I've also loved the units where ER would call and say, we have a __wkr, probable ___dx, ER doc wants a NST, do you want her in OB or to come down here? These nurses were great to work with and were frequently my backup for resusations.
To harry krishna - the only thing that OB should be wanting from you is a heads up that the patient coming up needs respiratory isolation. She was, IMHO, out of line. - doesn't your hospital have policies to cover this?
I work in a small county hospital on the night shift. Our policy is anything over 20 weeks comes to OB under that goes to ER. No patient is triaged by er before she comes up unless she came in via ambulance from mva, if they come in via ambulance complaining of labor they are brought directly to us. If they come in over 20 weeks complaing of any type ob symptom, ctx, bleeding, pain of any kinds, leaking fluid they are sent by admissions to us. Se if we get patients we should not get it is not er's fault it is admssions who did it. We have to go down and monitor MVA's patients until they are cleared by the er then we can bring them to the unit. The reason we do this is a matter of liability not laziness on the part of er. Likewise if we get someone up and check them out and find no ctx but a problem er should handle we call tell them we are coming and take them there. If all of us would realize part of the problem is patients coming for things they should have stayed home for but someone has to see them once they are here.
Specializes in obstetrics(high risk antepartum, L/D,etc.
True story. The lady didn't speak English--one of the middle eastern dialects if I remember. She wouldn't let anyone near her very large and firm belly, and was yelling very loud. One of her family told the ER that she had been having 5 minute pains for hours. I guess that qualified her for labor. No prenatal care, of course. We onkly got a call from ER that they were bringing up a NPC that seemed to be in "really good" labor. This is not an urban myth--I was there!! (And surprised as hell when we got the whole story, using an interpreter!)
Specializes in obstetrics(high risk antepartum, L/D,etc.
[Originally posted by harry Krishna]
Seriously doubt the one story about the 65 y.o female w/ ascites, sounds like an urban myth. ALL places that I have worked in you have to call upstairs to give some type of report, and I SERIOUSLY doubt they would ahve said "sure send the 65 y.o. lady up" come on!!!!!!
True story. The lady didn't speak English--one of the middle eastern dialects if I remember. She wouldn't let anyone near her very large and firm belly, and was yelling very loud. She kept her head covering on and hid her face in it. One of her family told the ER that she had been having 5 minute pains for hours. I guess that qualified her for labor. No prenatal care, of course. We only got a call from ER that they were bringing up a NPC that seemed to be in "really good" labor. This is not an urban myth--I was there!! (And surprised as hell when we got the whole story, using an interpreter!)
Actually, it was in a community hospital that the ER either refused or would not do fetal hearts...It didn't present a problem unless we were out straight but even then, no patient should have to wait for hours until an OB RN could come down and do one...I love the ER people in both hospitals I am talking about, and in fact, enjoy floating there BUT I still have found that although we do work together, there are still so many times that they turf inappropriate people upstairs either with the flu or a UTI, and then get perturbed when we evalutate the mom, discover she is really an ER patient and then attempt to send her back...
I know it isn't easy in either area.....
Funny quick story...Years ago the ER was hopping...EVERYthing was coming through the door. I was getting off an equally crazy shift on eves and went downstairs to the ER to pick up my best friend ( the ER charge nurse) so we could ride home together. No way was she getting out of there, and seeing how wild they were and continued to get, I decided to stay and help...Suddenly, a wheelchair with a hugely pregnant woman, screaming , gets thrust at me.....Shes all yours! And off they went...And here I am thinking, I am off duty, said I would help and now they have left me with a screaming non english speaking woman having twins...So, OB never leaves you!
Many times ER will call us to do FHT's when they have tried unsuccessfully. Our women's services unit will also call for us to do FHT's if they are having a problem. I think sometimes it's hard for us as L&D nurses to find FHT's on some patients let alone for someone who rarely does them to find them on a 13 weeker.
Our ER is usually pretty good and doesn't really try to turf us patients who should be there. However, we have some docs who will send down a pt who could just as well be treated with us. IE a 23 weeker with initial herpes outbreak. Already with us an hour assessment done, no other pts on the unit. This doc has us send her to a full ER to wait 3hrs for a shot of demerol! (which we could have given in 2 minutes) OH and her husband is an ER doc..... sound weird to you?
We are constantly working on our relationship with the ER. We had a tragedy about 10 years ago when a 34 week pregnant patient came into the ER after an MVA. She had abdominal pain and was being cleared for a neck injury. No one let L&D know she was there. After two hours she was cleared from the ER. When she got up to L&D she had FHTs in the 50s and was abrupting. Baby died despite crash C/S.
As a charge nurse I always want to know about any viable patients in the ER and when our ER staff is stable they generally do so. Every once in awhile you get an ER doc who wants to handle the patient. We have also had preeclamptic patients sent home from the ER without ever notifiying L&D because they don't recognize the patient as preclamptic.
At times it is very stressful for us to send a nurse to monitor in the ER until the patient is cleared but I just have to remind myself of the possible tragic consequences .
Sometimes I wonder about the folks down in our ER. 
Our ER does NOT triage OB pts, merely call up to the floor and say they are here come get them, so we don't get "report" from them. All pts are told to come through the ER unless they have called their doc and they've told them to come in. In this instance. if they checked the woman's pressure, they really should have relayed that in the message so a nurse could have gone down with the support tech. Luckily, this woman didn't seize in the elevator on the way up. 
Don't worry. ER has plenty of stupid pt stories to share. Like the ones who come in by squad because they lost their mucous plug, or because it is their due date.:roll 
working relationship between OB and ER and some have awful relationships.
mother/babyRN, RN
3 Articles; 1,587 Posts
Harry Krishna you can doubt ALL you like but the ER will send most minimally crampy 2 minutes pregnant people outrageously and ridiculously up to delivery and be gone before the wheelchair stops....And no, it is not unheard of to get the older people since many units are also OB GYN...I cannot begin to mention what inappropriate people the ER is quick to send upstairs KNOWING we don't see them before 20 weeks unless there is a pregnancy related issue....ALL THE TIME.......