questions about ob clinic

klone, MSN, RN · Feb 28, 2014

We have 2 providers (CNMs) each day as well as myself. Each provider sees 20 patients per day (20-minute slots for each patient, regardless of type of visit), and I see 7. My patient slot times depend on teh visit. A new OB intake gets 60 minutes. Family planning visits are 30 minutes. Pregnancy tests are 15 minutes.

We are paper charting

Labs are ordered on paper. For new OB patients, the lab slips are already pre-prepared with the labs we routinely do at intake, and then we can hand write any additional labs that might be needed (quantiferon, 1-hour GTT, etc). They are also preprinted with the ICD-9 code of V22.1, and if it's a primip, we just change the 1 to 0. That saves time. For gyn patients, the provider just writes in/checks off whatever labs they're collecting.

We have one MA for each provider, and then me. I have my own patient load. I see 3 OB intakes per day, 2 pregnancy tests, and 2 family planning appointments (DMPA, birth control refills, Plan B).

I also handle all phone triage. Our triage line actually rings directly to voicemail, and I check it every 1-2 hours, between patient visits, and then call patients back.

I also handle all the lab results - they come up from the lab on paper, and I go through them each day - any abnormal labs, I will contact the patient, get one of the midwives to write out an Rx as necessary, set up an appointment for the patient to come in for treatment (+STIs), record the OB lab results in the charts.

Each provider has two exam rooms, and I have my own room for seeing patients as well.

The MAs do vitals and urine dips for their providers, and I do my own vitals and urine on my own patients. The MAs also set up for procedures (paps, Nexplanon or IUD insertions) and make sure whatever is set out (endocervical swabs or Pap kits, for example) that is needed for that particular patient. They also room the CNM patients and turn over the rooms between the patients.

As it is not evidence based to do urine dips on every single OB patient, every single time, we do not do that. We do a baseline UA and culture at the first OB appointment. If the patient has a hx of UTI or pyelo, we will do a UA at every visit and a cx q trimester. And we will dip if the patient is having other s/sx of pre-eclampsia.

I have no idea how ANYONE would be able to see 30 patients with only one exam room, especially if the RN is the one assisting the provider, and is also expected to see new intakes and do phone triage.

Oedgar · Feb 28, 2014

I really like the idea of having pre-filled lab req's.

klone, MSN, RN · Mar 1, 2014

No, you're absolutely not crazy for feeling overwhelmed. I can't imagine doing all that and being able to see all the patients on time and do all that is needed to do. Just the logistics of turning over the room and getting vitals/urine and rooming a patient on time, with only one room - I honestly don't see how it can be done.

I'm sorry that your situation is how it is - I absolutely LOVE my job, but I don't imagine I would feel that way if my work environment was how you have described yours!

Oedgar · Mar 1, 2014

And realistically, we see anywhere from 16-24 pts a day, depending on the number of no-shows. But the days my doc is running full tilt, other doc is running full tilt, and we are all over each other with our on shared pt bathroom and work area for vitals, etc... it's pure chaosl.

Oedgar · Mar 1, 2014

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