HMC OB Workflow as of 11/10/21
Communication and Closed Loops:
- effective immediately: regardless of "who is on" for FM OB patients, our expectation is that the provider who is called will OWN THE COMMUNICATION
What does this mean?
This means there is never a situation where if you are called by an L&D RN that the response will be "Its not me"
If you are not on call, or don't do OB, or are on call but are not really available (regardless of the situation) if they call you, then YOU need to find out who to call, and YOU call the correct provider, and then close the loop with the RN. We MUST NOT ask or tell the RNs to call other people.
An example:
"Thank you for this call- is the patient stable and can I get back with you in 5-10 min or do you need someone at the bedside sooner? If it can wait a few minutes, let me get in touch with the person who is covering for us and someone will be back in touch with you in a few minutes..."
Timely Evaluation of Patients:
-Regarding timely evaluation: again, we are going to expect an upfront communication and closed loop plan betw the provider and the RN in real time.
If the RN describes an urgent or semi-urgent situation, the FM provider who is called will be expected to either present to bedside immediately if they are in house, (if they have OB privileges) regardless of "who is on call for OB", OR if not in house, they will arrange for immediate evaluation to happen by (you) reaching out directly to the in house OB provider or the in house FM-OB provider ("Hey- i am not in house but i just got called about a patient who needs urgent evaluation, can you please go see the patient and I will be en route- thank you!")
- if the Orange team or a nocturnist is called who does not have OB privileges: then once again, the script should be, "Thank you for this call- is the patient stable and can I get back with you in a few minutes or do you need someone at the bedside sooner? If it can wait a few minutes let me get in touch with the person who is covering for us and someone will be in touch in a few minutes"
- If they call the NON-Ob providers erroneously and they say that the patient needs immediate assessment, please let them know that you are not an OB provider and for patient safety they should reach out to the in house OB for immediate assessment, and then YOU will reach out to the FM OB provider and let them know there is an unstable patient, and that you have asked the RN to get the OB involved
- If they call the NON-OB provider erroneously and the patient is safe to wait, then the expectation is that you will reach out to the FM-OB provider yourself, and let that person know to call L&D
Summary
- no one is in trouble, this is not about blame.
- however, this situation has been escalated to the very top of the institution, and we need to change our approach immediately
- we need to own the fact that we have a somewhat complex system
- patient safety needs to be the #1 priority regardless of schedules, smartweb, SPOK, being in or out of the hospital, etc. I know we all prioritize patient safety. It is just that we need to have a different work flow to ensure it in this system
- if you feel like you have a better solution or would like to propose a different work flow, please feel free to bring