Re: Induction protocols
From: art fougner, md (evsono@pipeline.com)
Thu Mar 3 14:25:08 2005
Soprano Family branchin out to PR?
art
At Thu, 3 Mar 2005, Efrain Ramirez wrote:
>
>The pharmacy does a compounding procedure - dilutes the original
>suppository into equally 2 or 3 mgs vaginal ovules.. (I don't know the
>exact steps) but the amount is pretty much accurate..
>The key for success for inductions as far as logistics goes- is
>physician's cooperation - to stick to the rules - sometimes tricky when
>there are some "wise guys" ...
>
>Prepidil and cervidil are to expensive for our setting...
>
>>At Thu, 3 Mar 2005, Seele, Mona wrote:
>>
>>I am surprised that you are using the prostin because pharmacy has to cut
>>the suppository which means there is no guarantee of exact dose... we used
>>to use that prior to prepidl and cervidil days, but once those products were
>>available, we went to them. We also use cytotec, which is the cheapest, but
>>not all md's are using; however most use either cervidil or cytotec, not
>>much use of prepidil or laminaria.
>>
>>I work at the hospital that Dr. Chudacoff practices at and we do have an
>>unusually high number of inductions...simply to be sure that we can
>>accomodate all of our patients. We have guidelines for inductions and the
>>doctors are great about following the rules. A labor patient or a medically
>>indicated induction always takes precedence over an elective. We have a
>>couple of evening slots for induction and then two more for the am (four
>>induction slots total). We also have a slot for a 0730 and 1230 c/s that
>>can be used for induction if not being used for c/s. There are times when
>>we cannot accomodate that many inductions and then we prioritize according
>>to need first and when they were scheduled next. Usually we can get all of
>>them in and started sometime during the day they were scheduled, but if not,
>>then we move them to another day or the doctor takes them to another
>>hospital.
>>
>>We are so regimented because we have only 12 LDRP's + 3 triage beds and have
>>30+ OB/GYN's wanting to use the unit. We can utilize beds in the adjacent
>>unit for postpartum patients if we need to get a labor patient or medically
>>necessary patient in. Because there is such demand, the physician's have
>>been great about "the rules" and if someone violates they have also been
>>great about handling it amongst themselves.
>>
>>-----Original Message-----
>>From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net]On Behalf Of
>>eramirezt@coqui.net
>>Sent: Thursday, March 03, 2005 1:35 PM
>>To: Multiple recipients of list OB-GYN-L
>>Subject: Re: Induction protocols
>>
>>Cytotec was banned from our hospital - we are only using prostin
>>suppositories - outpatient preinduction ripening is not allowed by our
>>protocol.
>>
>>>At Thu, 03 Mar 2005, Andrew Folley wrote:
>>>
>>>Andrew responds:
>>>Thanks for the fedback. It sounds lie we all are seeing and doing more
>>>"elective" inductions. I do not think it is necessarily "bad medicine" but
>>>that it causes some logisitic prolbems and it may drive up health care
>>>costs. Many of our inductions come in the night before and are hospitalized
>>>with cervidil placement until am. I think the cervidil costs the hospital
>>>about $150 and the charge to patient and insurance is about $400 plus the
>>>expense of the extra day in the hospital. Any other thoughts on how we are
>>>doing inductions? Oral cytotec? vaginal cytotec? laminaria ripening?
>>>prostaglandin gel as out patient etc? andrew
>>>
>>>>From: islesannie@yahoo.com (Joanne Bulley, MD)
>>>>Reply-To: ob-gyn-l@obgyn.net
>>>>To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>
>>>>Subject: Re: Induction protocols
>>>>Date: Wed, 2 Mar 2005 21:55:12 -0600
>>>>
>>>>This sounds like something the chair of the dept would need to hold some
>>>>pow wows on -- rather than declaring the plan. One there is a plan,
>>>>however, then there has to be a dicision on implementation.
>>>>
>>>>In residency with a dept of about 30 OBs ... yes - al iinductions were
>>>>booked with L&D and the log was kept with the reasons etc. We really
>>>>didnt' have many that were the truly elective ones -- and if we got more
>>>>than we were agreed to handle the least urgent w=ones were put off --
>>>>and I would guess that if we had a new policiy that it would be the dept
>>>>chair (or his / her designee) that would be called if some irate doc
>>>>called up demanding that patient Ms Doe be put on and there was either
>>>>no room -- or it was not indicated.
>>>>
>>>>Joanne
>>>>
>>>>At Wed, 02 Mar 2005, Andrew Folley wrote:
>>>> >
>>>> >Dan
>>>> >How does your hospital enforce the policy? ie how far in advance does
>>>>one
>>>> >call to reserve a day for induction. Dioes L and D keep a log? do you
>>>>have
>>>> >strict criteria for inductions to be met? I think our induction rate
>>>> >(medically indicated and "elective" is about 30% which is alarmingly
>>>>high.
>>>> >Andrew
>>>> >
>>>>
>>>>--
>>>>Joanne Bulley, MD
>>>>Keene, NH, USA
>>>
>>>_________________________________________________________________
>>>_________________________________________________________________
>>>_________________________________________________________________
>>>
>>--
>> I think I will do nothing for a long time but listen,
>> And accrue what I hear into myself...and let sounds
>> contribute toward me.
>>
>> ~walt whitman~
>>
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>--
> I think I will do nothing for a long time but listen,
> And accrue what I hear into myself...and let sounds
> contribute toward me.
>
> ~walt whitman~
>
--
art fougner, md
"If you don't know where you are going, you will wind up somewhere else."
Lawrence Peter Berra
