Re: Induction protocols
From: Seele, Mona (Mseele@tmh.tmc.edu)
Thu Mar 3 16:35:23 2005
Sure
-----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 5:28 PM
To: Multiple recipients of list OB-GYN-L
Subject: Re: Induction protocols
May I have your permission to copy paste this?
>At Thu, 3 Mar 2005, Seele, Mona wrote:
>
>Thank you for that, I appreciate the compliment, but it wouldn't work
>without everyone's cooperation. I have never worked with a group of
doctors
>that are as committed to ensuring that the system works...usually there are
>a few that can only see their own point of view and they tend to spoil the
>works for everyone. I do not feel that this happens here and it is great
to
>work with physicians who do not try to push or "game" the system to their
>own advantage and who work in such a cooperative manner. Not that ya'll
>are perfect (none of us are) but I appreciate how special you are.
>
>-----Original Message-----
>From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net]On Behalf Of Richard
>Chudacoff, MD
>Sent: Thursday, March 03, 2005 4:13 PM
>To: Multiple recipients of list OB-GYN-L
>Subject: Re: Induction protocols
>
>Actually, Mona has turned this L&D into the most efficient LDRP only system
>I've ever seen. Doubt we would be able to get as many deliveries done there
>without elective inductions
>
>Richard Chudacoff, MD
>
>-----Original Message-----
>From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Seele,
>Mona
>Sent: Thursday, March 03, 2005 2:25 PM
>To: Multiple recipients of list OB-GYN-L
>Subject: Re: Induction protocols
>
>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
>30+ 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
>>
>>_________________________________________________________________
>>Is your PC infected? Get a FREE online computer virus scan from
>>_________________________________________________________________
>>_________________________________________________________________
>>McAfee(r)
>>
>>--
>>_________________________________________________________________
>>Security. http://clinic.mcafee.com/clinic/ibuy/campaign.asp?cid=3963
>>_________________________________________________________________
>>_________________________________________________________________
>>
>--
> 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~
>
>-----------------------------------------
>Methodist. Leading Medicine. ***CONFIDENTIALITY NOTICE*** This e-mail
>-----------------------------------------
>-----------------------------------------
>-----------------------------------------
>is the property of The Methodist Hospital and/or its relevant affiliates
and
>-----------------------------------------
>may contain confidential and privileged material for the sole use of the
>-----------------------------------------
>intended recipient(s). Any review, use, distribution or disclosure by
>-----------------------------------------
others
>is strictly prohibited. If you are not the intended recipient (or
authorized
>to receive for the recipient), please contact the sender and
>delete all copies of the message. Thank you.
>
>-----------------------------------------
>Methodist. Leading Medicine. ***CONFIDENTIALITY NOTICE*** This e-mail
>-----------------------------------------
>-----------------------------------------
>-----------------------------------------
>is the property of The Methodist Hospital and/or its relevant affiliates
>-----------------------------------------
>and may contain confidential and privileged material for the sole use of
>-----------------------------------------
>the intended recipient(s). Any review, use, distribution or disclosure by
>-----------------------------------------
>others is strictly prohibited. If you are not the intended recipient (or
>authorized to receive for the recipient), please contact the sender and
>delete all copies of the message. Thank you.
>
--
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~
-----------------------------------------
Methodist. Leading Medicine. ***CONFIDENTIALITY NOTICE*** This e-mail
-----------------------------------------
is the property of The Methodist Hospital and/or its relevant affiliates
-----------------------------------------
and may contain confidential and privileged material for the sole use of
the intended recipient(s). Any review, use, distribution or disclosure by
others is strictly prohibited. If you are not the intended recipient (or
authorized to receive for the recipient), please contact the sender and
delete all copies of the message. Thank you.
