Why have a designated Obstetric ED?
Having an OB ED specific designation improves our ability to charge better rates on the hospital side, as compared to the current state, since we are not a designated ED.
Having an OB ED allows our physicians to drop DIFFERENT charges under an ED Designation, outside of the global even if they are our patients presenting to be evaluated.
Having an OB ED allows us to improve our staffing on SMMP, given requirements under and Emergency department designation.
Internally, having a designation of an OB ED aims to align expectations of timeliness for ancillary services, consulting services etc. with the Adult ED.
What about patients with concern for miscarriage?
We will be going back to accepting and directing patients with vaginal bleeding at less than 12 weeks and a KNOWN pregnancy, like we did during the COVID response timeframe.
This is because of a decreased waiting time for patients as compared to Adult ED, helping to offload the Adult ED volume
There is also a decreased waiting time for access to an operating room if needed for D+C, can be done on SMMP
This provides streamlined counseling/follow up planning for SAB patients, and consolidation of supplies and resources specific to early pregnancy complaints, issues etc.
This provides Improved consistency in messaging about where patients should present when counseled in OB visits
The OB Team is responsible for seeing patients since they are in the OB ED, we have a designated OB 2 attending, and a swing shift resident. If we are busy and unavailable on OB, and GYN is available, it is fine to have them as back up or to help. However, do not wait to evaluate, manage, and treat the patient waiting for the GYN team, the primary responsibility is the OB team staffing the OB ED.
IF the patient is unstable, use standard protocols to get assistance, i.e. Rapid response, and can transfer to ED after an MSE completed.
IF the patient needs and OR for suspected or ruptured Ectopic pregnancy, the patient should go to the MC OR, not CH. Follow the algorithm regarding correct OR utilization (dependent on where the patient is admitted and where they will go post op). This is when the patient would be expected to shift to GYN as primary service.
Patients to be seen in the SMMP OB Emergency Department are as follows:
Any STABLE patient <12 weeks with uncontrolled Diabetes (type 1 or 2), uncontrolled hypertension, hyperemesis, COVID-19, or vaginal bleeding in the setting of a known pregnancy.
Any STABLE patient >12 weeks with nearly ANY chief complaint, DOES NOT necessarily need to be OB related
OB Trauma activations, patients who are unstable, on mechanical ventilation, vasoactive drips need to go/stay to the ADULT ED
ANY OB patient in the ED who is >12 weeks and does not meet criteria to come to the Obstetric Emergency Department needs an OB consult regardless of complaint or reason for visit.
Any STABLE Postpartum Patients up to 6 weeks, regardless of where they delivered or chief complaint
Obstetric patients presenting in the Emergency Department in any unstable condition or a condition requiring life support measures shall be stabilized in the Emergency Department before transferred to OB ED or SMMP. Electronic fetal monitoring shall be the responsibility of the SMMP staff when/if required
What if a patient goes to the wrong place?
If a patient presents to ADULT ED and meets the above criteria, they should receive an MSE and be sent up to SMMP OBSTETRIC ED
If a patient presents to SMMP OBSTETRIC ED and is unstable, not actually pregnant, they should have a OB RAPID RESPONSE called if needed, and/or given and MSE and sent to the ADULT ED
Given the separate license of CH and MC, an MSE MUST be done to avoid any EMTALA violation concerns.
What about the workflow and “clogging” up the OB Emergency Department with SAB patients?
As long as the SAB patients are stable, our goal is not to have more than 1 of these patients roomed at a time. This is to protect the other rooms for OB patients and true emergencies.
If the patient is waiting on an ultrasound, labs etc., that may not necessarily require them to be in a room
We want to help the Adult ED and no matter how long they are waiting it will likely be less than what they have to wait in the Adult ED.