Hospital Settingob-gyn

L&D/Obstetrics Department

  • Annual Deliveries: 1,600
  • L&D Recovery Beds: 12
  • Dedicated Obstetric Operating Rooms: 2
  • NICU: Level III

Emergency Department

  • Annual visits: 53,000
  • ED beds: 24
  • Trauma Designation: Level II
  • Admission Rate: 25%

Challenge

  • To provide 24/7 on-site ED/OB physician services
  • Many obstetric emergencies require expeditious delivery (i.e., abruption, cord prolapse, uterine rupture, and terminal deceleration)
  • Immediate intervention is required in patients with postpartum hemorrhage
  • Overuse of oxytocin in effort to rush delivery

Solution

  • Provide 24/7, in-house, board certified/board eligible Ob/Gyn physician
  • Respond to every patient presenting to the OBED for evaluation
  • Designate 2 OB beds as EDOB beds
  • Relieve RN from triage/screening exam
  • Provide labor/inpatient management of unassigned obstetrical patients
  • Provide operative and inpatient management of unassigned gynecological patients
  • Surgical assistant at Caesarean sections performed by community physicians
  • Provide night/weekend/vacation coverage for community Ob physicians
  • Provide inpatient and observation Gyn consults
  • Bimonthly series of drills on the unit addressing issues such as shoulder dystocia, post-partum hemorrhage, emergency c/s, etc.

Benefits per Expected Results

  • Elective induction rate <40 weeks decreased 73% in first two quarters (decreased from 7.6% to 2%)
  • Primary Caesarean delivery rate in term, primaparous pregnancy 14%
  • 24% overall Caesarean delivery rate
  • Increased physician willingness to encourage trial of labor after Cesarean section (TOLAC)
  • Vaginal birth after C-section (VBAC) success rate 50% higher than community providers