What's your policy?

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Specializes in Obstetrics, M/S, Psych.

If a patient that does not have a hospital careprovider, (so no previously known doctor eval or prenatals), shows up at the ED to be evaluated for labor, does the ED doctor see them before they are sent to the OB unit or do they go directly to OB for the initial evaluation by an RN there. (There is no doctor on the OB unit.)

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

If gestation is greater than 20 weeks, they come directly to OB where WE monitor them and call the ON CALL FOR 'NO DOC" doctor (at home on nightshift, of course), to come see and evaluate her. Usually,we then wind up delivering the patient if in labor and term. Or after being seen by a doctor,if need be, shipped to the nearest Level 3 facility , if her condition warrants this.

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Specializes in Obstetrics, M/S, Psych.

Thx, SBE. The reason I ask: Where I work, it used to be that we had the ED doc do an initial eval regardless of gestation and then the patient was sent to OB afterward. The rational was that if the pt. had no previous contact with the facility, therefore no records, then it was best for the ED doc to evaluate first. Apparently, that policy changed and we now do the same as you describe, but was not put in writing. So some of us thought it was one way, some the other. The OB doc O/C wasn't entirely sure so he is going to talk to the head doc of the ED adn get a written policy on it made up, which of course should have been there in the first place. I don't care which they choose, but I hate it when something is done one way, then out of the blue, the rules are different now. Irks the crap out of me and happens way to often at this place! :( Anyway...just venting now..TY for the response!

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Pregnancy at any gestational age (after 20 weeks) is always evaluated in the OB department. Our docs all take a rotating call for the "unassigned" patient. Our ER wants NOTHING at all to do with anything pregnancy related! They pudh them at us!:chuckle

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

It needs to be in writing, especially with the very strict EMTALA laws.

I guess I am used to this---as long as I remember, we have been the primary point of triage for ALL pregnant patients over 20 weeks' UNLESS the condition she reports HAS NOTHING TO DO WITH HER PREGNANCY. (e.g. a broken finger). Even THEN, we are called down to do a doppler on the baby and record fetal heart tones for the record in the ED. Or, if in doubt, they sent up to us for monitoring for 30 min or so, if the ED doctor feels its warranted.

We are seeing more and more "no-docs" and failed homebirths lately. I just hope we can get our staffing up to par to keep up with this increasing census! It can really get hairy for us at times. And I only see it increasing as times goes by.

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Specializes in Obstetrics, M/S, Psych.
It needs to be in writing, especially with the very strict EMTALA laws.

Exactly, Deb...that is all I want. First it was one way, then it is another. I have no problem with the stray patient, but I do want my butt covered and I definitely want a doc in there to evaluate her, too. I hope they take care of the problem, but...

It is a moot point now, anyway as I am done OB for awhile as of today. New job in psych starting next week!:D After 8 years in the same place change is due, but I know I'll do OB again someday. It's in my blood like psych is.

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