Re: Emporia ---> Process errors
From: Garry E. Siegel, M.D. (garrys@mindspring.com)
Tue Dec 7 10:59:38 2004
In the mid 90's after the HMOs mandated going home after 1 overnight
(vaginal) and 2 overnights (C/S), our state passed a law that allowed up
to 2 overnights/4 overnights, respectively.
As we all know, some C/S can really go home easily 2 days later, others
"need" 3 or 4 days. Ditto for vaginal deliveries going home in 1 or 2
days. It may related to time of delivery, parity, inherent patient
factors (i.e. good or bad protoplasm), as well as their expectations.
All of those are hard to quantitate and set up rules, so the insurers
simply set reasonable guidelines based on some company (Roberts and
Millman?? In Seattle??) who tells all.
Most of my vaginal deliveries leave in 2 days, around 15% in one day.
C/S--most in 3 days, 15% in 2 days, 5% in 4 days.
Garry
At Tue, 7 Dec 2004, Myer Bornstein wrote:
>
>Glen
>In Massachusetts the law on the books is the patients can stay up to 4 days
>after C/S/ I use to send my patients home in 48-72 hours and offered that
>to the patients, most elect to stay 96 hours
>
>--
>Myer S. Bornstein, MD, MMM, FACOG, FACPE, CPE
>-----Original Message-----
>From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Elrod
>Darryl G MAJ 48 MDOS/SGOBO
>Sent: Tuesday, December 07, 2004 7:58 AM
>To: Multiple recipients of list OB-GYN-L
>Subject: Re: Emporia ---> Process errors
>
> At a recent medmal conference I attended the plaintiff's lawyers
>stated that when there are risk factors for SD, such as excessive
>maternal weight gain, suspected macrosomia, diabetes, or protracted
>labor, then you should discuss this with the patient and "offer her a
>c/section to avoid shoulder dystocia." On the one hand, some would
>avoid and operative vaginal delivery if such risk factors exist, but I
>wonder what this line of thinking would do to the national c/section
>rate.
>
> Ashley
>
>Sort of off topic, but I recently looked over an article about the
>rising csection rate and specifically looking at the effects of this on
>LDRP numbers. I was amazed to see that they were using as their
>assumption that csections stayed an average of nearly 4 days!
>
>I'm curious how long others keep the scheduled csections. I have only
>had a handful in the last three years stay longer than 48 hours. I
>can't imagine keeping a section for longer than three days baring
>complications.
>
>Glen
>
>D. Glen Elrod, Maj USAF, MC
>Obstetrician/Gynecologist
>Maternal Child Flight
>48 MDOS/SGOBO
>UNIT 5210 Box 23
>APO, AE 09464
>DSN (314) 226-8334
>Comm 01638-52-8334
>
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--
Garry E. Siegel, M.D.
Private Practice
Roswell, GA
