OB Continuity Recommendations

To improve continuity, please do the following:

1) When you see an OB patient in clinic that is not being followed by a resident, pick them up as your own. Adding yourself as resident PCP does NOT show in the banner for the midwives or L&D staff. You need to add a statement to the overview for "Pregnancy" in the problem list: "GME OB Continuity patient. Please contact Dr. (you) when this patient is admitted in labor."

If someone already has a continuity resident, you can add yourself as “Backup continuity” in case the primary resident is away/unavailable at the time of delivery. Add to the statement “If Dr. X not available, please contact Dr. Y”

Help each other out, if you see a patient in clinic that has been seen by a resident and doesn't have them listed in the Problem list overview, please add them.

I also encourage you to keep your own list of continuity patients you pick up, as well as their due date, so you can keep track of who is coming close to delivery and check in on their charts.

2) Build a relationship with your patients. When you see them in clinic, give them your card, explain that you will try to see them for most of their visits and that you want to be there for them when they deliver. Ask them to remind the midwife to call you when they are admitted in labor.

3) Be proactive in scheduling. I have left copies of the resident schedule in the nursing pod where the midwives hang out. Know when you will be in OB clinic next time and schedule the patients to return at that time. In the follow up section of epic in check out comments, write "return for 32 week OB visit on 3/10/15 in the AM." You must specify AM or PM when you will be in clinic. If the patient needs to return in 2 weeks, write in the comments to schedule the next 2 appointments so you know they will stay on your schedule in 4 weeks "schedule 34 week OB f/u 3/10/15, and schedule 36 week OB f/u 3/24/15 in the AM."

Again, help each other out. If you see that a patient saw a resident in the past, look at the upcoming schedule and try to specify a follow up that will get them back in to see that resident again, even if it alters the regular follow up by a week (ie 3 weeks instead of 4).

4) Before the start of OB clinic, look at the schedule carefully to see if you are assigned to any of the patients that day to make sure you see them.

5) Don't forget to look at the OB clinic column in the schedule and GO TO OB CLINIC when you are scheduled. Several times the midwives told me they were surprised they had entire days without a resident in clinic, and when we looked at the schedule, someone was supposed to be there.

6) Continuity deliveries take precedence over all other responsibilities. You are excused from your regular rotation responsibilities, and can even leave your residency continuity clinic (please notify the desk attending and Danasha) for imminent deliveries. Continuity deliveries are the one exception to breaking duty hour rules in the ACGME policies. The only reason to miss a continuity delivery is if you are on vacation.

7) Resident on OB - if you admit a patient in labor from the GME clinic, call the resident listed in the problem list as their continuity first. If they cannot be reached and another resident has seen the patient at least once during the pregnancy, call them.

To define continuity, the faculty have agreed that you can count continuity for a delivery if you have seen them at least twice other than their admission for labor and participate in their delivery. The 2 OB visits can include prenatal clinic visits, the postpartum visit, and OB triage evaluations (but not the one when they present in labor). Both c-sections and vaginal deliveries can count for continuity.

To review delivery requirements:

You must log at least 40 deliveries. up to 10 of those can be c sections. At least 10 of those must be continuity (vaginal or csection). When you log your deliveries, you should log continuity delivery and vaginal/csection delivery as separate procedures.