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Re: Non-reassuring tracing in latent phase Family doc and Head nurseFrom: Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C. (johnprov@sympatico.ca)Tue Apr 28 11:33:57 2009
At Tue, 21 Apr 2009, Charlie Chambers wrote: > >Along those lines, how many of you practice in hospitals where >guidelines for consultation are explicitly spelled out, or for >comanagement or assumption of care? We currently do not have anything >that guides those situations and it scares the heck out of me when I >later find out about some of the things that mid level providers were >managing without me being in the loop. > >****************************************************************************** >Charlie Chambers >Hood River, OR USA
> Charlie here is what we use for the Family Doc's, I think guidlines are reasonable, I don't think the transfer of care wording is helpfull, as far as I am concerned once I am consulted any concerns can be redirected to me I have no problem with that, I prefer that family doc's notify me if they are doing a vacum after I have been consulted, especially if my assesment showed the baby to be OP, some do not do the courtesy of calling to tell me they are attemping a vacum delievery. If I have not been consulted they can do what ever they want to do and I don't consider myself responsile for thier mangement untill consulted. • Normal vaginal deliveries (cephalic presentation). • Vaginal deliveries requiring vacuum extraction. This process should be properly documented in a contemporaneous fashion in the patient’s chart. Nursing staff should be made aware by both Physicians of the patient’s status and be made aware of which Physician to address when concerns arise. Essentially a consultation does not imply a transfer of care. PROCEDURE Transferal of care can only occur once a discussion and consensus has been reached between the patient, the referring Family Physician and the consultant Obstetrician. This process should be properly documented in a contemporaneous fashion in the patient’s chart. Nursing staff should be made aware by both Physicians of the patient’s status and be made aware of which Physician to address when concerns arise. Essentially, a consultation does not imply a transfer of care. The term “courtesy catch” should not be used as it is not recognized by the billing authorities. Consultation with an Obstetrician/Gynecologist (OB/GYN) is required for moderate risk conditions. It is understood that if the consulting Obstetrician deems it appropriate, he/she can assume care of the patient, although the Family Physician can follow the case along. For high-risk cases, transfer of care to the Obstetrician is to take place, although the Family Physician can follow the case along. Although not meant to be limiting and all-inclusive, the following represent cases of moderate risk needing consultation: 1. Insulin dependant diabetic pregnant patient. 2. Mild to moderate pregnancy induced hypertension. 3. Non reassuring fetal status. 4. Induction of labour (any reason). 5. Augmentation of labour with Oxytocin. 6. Prolonged rupture of membranes greater than twelve (12) hours of labour is not established. 7. Prolonged labour longer than eighteen (18) hours. 8. Prolonged active phase of labour (less than ½ cm dilation per hour in a two (2) hour period when patient is in active labour). 9. Prolonged pushing of second stage of labour unless delivery is imminent (Primipara two (2) hours or Multipara one (1) hour). 10. Any births under thirty-five (35) weeks gestation. 11. Retained placenta greater than thirty (30) minutes. CATEGORY: Policy and Procedure PAGE: 2 of 2 Subject: CONSULTATIONS – FAMILY PHYSICIANS 12. Repair of third of fourth degree perineal lacerations and/or major vaginal or cervical lacerations. 13. Antepartum, intrapartum or serious postpartum infections. 14. Preterm rupture of membranes. Although not meant to be limiting and all-inclusive, the following represent cases of high risk needing consultation: 1. Abnormal presentations. 2. Multiple gestation pregnancies. 3. Major antepartum, intrapartum or postpartum hemorrhages. 4. Severe pregnancy induced hypertension. 5. HELLP syndrome.
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Take care, John
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