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Re: New Series #1-Admission and NSVD of laboring patients From: Garry E. Siegel (garrys@atl.mindspring.com) Tue Dec 31 14:41:47 1996 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Kelly Shanahan: "abdominal-pelvic masses" Previous message: dahmd@gate.net: "Re: micronized oral progesterone" Maybe in reply to: MBK80@aol.com: "New Series #1-Admission and NSVD of laboring patients" Next in thread: MBK80@aol.com: "Re: New Series #1-Admission and NSVD of laboring patients" At 12:18 AM 12/31/96 -0600, you wrote: > Thank you for supporting this concept. The format is open to improvement, >criticism etc. Lets not give up intellectual individualism but share ideas >that will help each of us continue to be creative, productive and cost >effective. > >For the first case in the series, lets discuss the tests and supplies we use >as we care for the laboring patient. Lets assume for this case that the >result will be a NSVD. VBAC and C/S to be discussed at another time. These >are uncomplicated primigravidas and multiparas. > >1-Admission- Admission should be ordered when patients are in active labor. >Admission in the latent phase (<3cm) may result in prolonged labor, >unnecessary invasive procedures, higher c/s rates, and greater expense. Sometimes it is hard to send prodromal primips home for social reasons. I fully agree with your statement re: procedures, etc. > >Tests ordered- CBC Georgia law (Jay and I are in metro Atlanta) requires a 3rd trimester RPR; my 2 hospitals do it with the CBC mainly for patient convenience, ie they do not need to be stuck in the office in the 3rd trimester normally. > >Monitors- as you deem necessary- Many hospitals now are on a case rate and >monitoring does not cost more, however, remember it "costs" the hospital to >use a monitor , for its monitor paper, fileing, nurse observers, etc. I think >we are all familiar with the literature on monitoring . Remember that >internal monitors are very expensive. Some med mal insurance carriers (including mine) give you a "good driver" discount for various procedures and documentation, including monitoring. > > >Delivery- Food for thought- >did you ever look to see how much of the pack you don't use. Do you use >drapes??? > An exception may be the catch all under buttocks drape that keeps the blood and fluid off of the floor. I haven't any idea if it is cost effective, but it keeps our shoes cleaner, and cuts down on housekeeping services. -- Garry E. Siegel, M.D. Roswell, Ga. Next message: Kelly Shanahan: "abdominal-pelvic masses" Previous message: dahmd@gate.net: "Re: micronized oral progesterone" Maybe in reply to: MBK80@aol.com: "New Series #1-Admission and NSVD of laboring patients" Next in thread: MBK80@aol.com: "Re: New Series #1-Admission and NSVD of laboring patients"

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