It's amazing how much we can fluctuate in our census on L&D from one day to the next.
For days, we were jam packed, constantly busy with rule out labors that were admitted, babies born left and right, etc. I know I've said that I enjoy doing OB triage, but it was just ridiculous when we were admitting EVERYONE, and there were no beds to admit them to on the L&D unit. And yet, there were more waiting in the waiting room, or standing at the main desk on L&D.
Note to the charge nurse: I really don't care if the patient is a high ranking official/has such-and-such of a profession. If she is not actively laboring or delivering right NOW, she will wait in the waiting room until I have a bed available! Seriously! I cannot discharge anyone until their MD/CNM has determined that they can go home! Without someone being discharged first, if I don't have an empty bed/stretcher for someone to be assessed, that means they have to wait.
Note to patients: unless you are actively bleeding, or the pain is severe, it's more than likely NOT an emergency, and you really should listen to your MD/CNM when he/she tells you not to come in to L&D. Oh heck, let's get to basics: CALL YOUR PROVIDER FIRST. It's their job to determine on the phone if you should come in to the hospital to be seen.
Note to the other triage nurse: if I can fully admit several patients at one time, then surely you can too. If you have time to gripe about not getting your admissions completed from 4 hours ago, then you have time to admit them, do you not?
Baby coming out right now? Yep, I will find a space for you, I will CREATE a space for you where none should physically exist.
Contractions started 10 minutes ago? HA! Girl, you're waiting in the waiting room. That woman over there with the baby coming out of her vagina? She comes first, thankyouverymuch.
8 comments:
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One summer we were bursting at the seems at our hospital..waiting room is full. Pt and hubby are there to be induced...they used the decreased fetal movement card when giving their contact info and insurance cards..and when we tried to put them on monitor in triage they got po'd that they were not being admitted! Then they admitted that the baby was moving!!
Another time a FOB was getting irrate because his primip wife (1cm w/ ctx 10-15min apart) was not being admitted right away because three pts came in one right after the other multips, hispanic: 8cm, pushing, and 6cm. He started spouting some racist nonsense. So the next day a good 16 hours later their baby still had not been delivered; yet we were supposed to get her into a bed and let those other ppl deliver in the waiting room!!!
ha! so true...so true!
agree!
"If you have time to gripe about not getting your admissions completed from 4 hours ago, then you have time to admit them, do you not?" Can I ever relate. I have noticed that the ones who get the least amount done are the ones who chronically whine about having too much to do!
Curiosity question...does having dedicated "triage" rooms really help with patient flow? In my area there are 2 hospitals that do not have triage areas at all in their LDR--the two smallest. 3 hospitals have triage areas, but one doesn't use theirs unless they are out of regular labor beds. Only the two largest hospitals routinely use their triage rooms, even in some cases where admission is not a question (VBA2C mom with a unicornate uterus past her due date and reporting contractions for past 2 days, regular for past 12 hours...can't tell me she wasn't going to be admitted!).
It would seem to me that having a triage area just creates more work--when a woman comes in she then needs to be transferred out of that room to a labor room, and it has to be cleaned. Using labor rooms as triage rooms eliminates the need to transfer/clean for the women who are admitted, but I'd think it is no more difficult to change the sheets on a labor room bed and clean things up for a woman who is not admitted as it is to do that in a triage area. But I'm not working in that area...can you shed some light on how having a triage area helps?
Also, I have a question about how a cesarean recovery area that has curtained off areas rather than sound barrier walls can be HIPPA compliant? Often parents are told they can't go into the newborn nursery because they might over hear what is being said about other babies, and that would violate HIPPA, but it seems if that is true for the babies, the cesarean recovery area is similarly problematic. So..is this a "true" concern, or just a manufactured excuse to keep parents out of the nursery?
We do have dedicated triage rooms (7 of them). They are separated by curtains, so not much privacy. If someone is obviously in labor/ruptured membranes, we skip triage and go right for a labor room. The triage beds are stretchers with minimal equipment in the immediate area, so they clean up much faster versus putting someone in a labor room and sending them home and having to clean the labor room.
Our PACU beds (4) are separated by curtains. Rarely do we have more than one or two patients in PACU at one time. So privacy is not necessarily a concern. We also only allow one support person with the mother/baby in the PACU, so we do not have tons of visitors parading in and out.
As for privacy concerns and the nursery: I would imagine it's more for the infection control aspect. Would you want strangers (visitors/other parents) in the same room as your baby in the nursery? How about all of their own associated germs? Best to keep baby out with mom in the first place, right?
work in a community hospital, 8 labor suites, 4 triage rooms, 2 OR and 2 recovery room beds seperated by a curtain. Couldn't live withut our triage rooms!!! we use them for our scheduled NSTs, ER OB checks, R/O labor and R/O SROM... we also use the triage rooms to admit our scheduled C-sections
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