Re: Emporia ---> Process errors
From: Joe Cutchin (forcep@intercom.net)
Wed Dec 8 08:17:26 2004
As well as lawsuits.
"Braun, R. Daniel" wrote:
>
> 100% C/S rate will eliminate need for LDRP's and also eliminate 48 hour
> use of LDRP's for inductions and prolonged labors.
>
> Dan
>
> R. Daniel Braun, MD
>
> "If everyone likes you, you're doing something wrong."
>
> Kinky Friedman
>
> I believe a self-righteous liberal or conservative with a cause is more
> dangerous than a Hell's Angel with an attitude.
>
> Andy Rooney
>
> -----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: Wednesday, December 08, 2004 2:48 AM
> To: Multiple recipients of list OB-GYN-L
> Subject: RE: Emporia ---> Process errors
>
> I'm just concerned that this article I looked at used these inflated
> numbers for LOS to show how with a rising csection rate, we are going to
> essentially bottleneck (to borrow a phrase) the vast majority of LDRPs.
> I can't see how even a 5 or 10% increase in sections could have that
> much effect, especially if we ever get to csection on demand.
>
> 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
>
> Notice of Confidentiality
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> Portability and Accountability Act (PL 104-191) and its various
> implementing regulations and must be protected in accordance with those
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> for full details.
>
> -----Original Message-----
> From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Garry
> E. Siegel, M.D.
> Sent: Tuesday, December 07, 2004 6:02 PM
> To: Multiple recipients of list OB-GYN-L
> Subject: Re: Emporia ---> Process errors
>
> 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
> >
> >Notice of Confidentiality
> >Under the Privacy Act of 1974, you must safeguard all information
> >reflected on this Email and, if applicable, all attachments.
> Disclosure
> >of information is IAW AFI 33-119, AFI 33-127, AFI 37-131, AFI 37-132,
> >AFI 33-219, and PL 93-579" This document may contain information
> >covered under the Privacy Act, 5 USC 552(a), and/or the Health
> >Insurance Portability and Accountability Act (PL 104-191) and its
> >various implementing regulations and must be protected in accordance
> >with those provisions. Healthcare information
> is
> >personal and sensitive and must be treated accordingly. See
> ><https://sg.usafe.af.mil/HIPAADisclosure.cfm> for full details.
> >
>
> --
> Garry E. Siegel, M.D.
> Private Practice
> Roswell, GA
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