Things aren't going to change. In my little town of 14,000, the local hospital sees about 180 patients a day. If a woman comes in pregnant and 4 or more cm dilated, the ED physician is expected to deliver the patient, resuscitate the baby and then, and only if they are stable, transfer them to the OB staffed hospital 50 minutes away. There obviously is no OB, no NICU, no backup of any kind. I interviewed there for nights before going FT telemedicine thinking to keep my skills up just in case, but when the chair explained this policy to me, I politely refused. What happens if she's breech? What if there are decels? Are we expected to do a bedside C section? Am I expected to repair that grade 3 vaginal tear? We are not obstetricians. And, trying to do that while running a department with that volume is only asking for trouble. The ED is a high risk place as it is no matter where you work. This, again, should be a national discussion.
At my last full-time ED job, I was presented with a patient fully dilated, -2 station, no prenatal care at a hospital with no OB, Peds, as my first patient of the day. The night guy couldn’t wait to leave. Knowing that the week before, none of the nurses knew what to do when I had a patient who needed a chest tube (I had to find the kit, set up the wall suction, etc.), I contacted an OB at the mother ship; she both refused the patient and wouldn’t come over to help (30 minutes away). I ascertained that it wasn’t a breech, but labor wasn’t progressing. After 30 minutes, I had the ALS unit that had transported her take her to the mother ship hospital (I know, EMTALA, but she was as stable as I could hope). Fortunately, the delivery went well, but I was roundly criticized for the transfer. I asked the PTB what they would have done. Crickets. I decided I was the dinosaur and retired.
What an absolute nightmare. I think that the mentality is, once they’re in our department, they’re our problem and ours alone. Glad you escaped it all.
I used to work in a small town hospital as a family doctor. (Town was population 10,000) We had OB, but not always in house. So, while I was there at 2 am tending an ICU patient, occasionally the L&D nurse would call over the intercom, “Any doctor in the house to OB stat”. Yikes. Usually that meant I did a fast delivery before the OB arrived to the hospital. That hospital is now closed. Those women have to drive a full hour now to the nearest hospital with ER and OB. Some deliver in the car on the way. Not optimal by any measure.
I was working ER/urgent care one Saturday when our paramedics got called out to a woman delivered at home. She had an abruption of a small for gestational age 37 weeker that was birn by the time the paramedics arrived. Her 10 year old son was the only one home ( husband was at work). Baby and mom turned out fine, dropped her glucose slightly while we waited for the NICU transport team to arrive. Mom and babe went to the hospital with the NICU and were just fine. The paramedics had just reviewed emergency birth procedures and I was studying NRP. Saw mom and babe a few times after, mom still remembers my being there to take care of her baby ( I was a former NICU nurse)
Unless…things…change…the Big, Beautiful Bill is going to be passed and more rural hospitals will close. Why on God’s green Earth are we allowing this to happen?!
I'm not trying to defend the Biden Administration Ed, but what-about-ism aside, and on point, the Trump spending bill will gut Medicaid and thousands of people will lose their access to health care. Small hospitals...mostly in rural areas, will be forced to close. Those seeking urgent/emergency care, including OB, will have to travel much greater distances to receive the care they need at the nearest operational ER/hospital. This will surely put more burden on an already broken system. Physician burn-out is bound to increase. I am no politician or social planner, but the scenario seems grossly predictable to me. If I am walking on a trail and hear the rattle of a pit viper, I usually take a step back and choose an alternate route. Pardon the metaphor, but shouldn't we be doing the same? Before we as a country take the next step, it is lunacy to not have another plan in place... if we truly care about the healthcare needs of our rural and poor urban citizens.
Things aren't going to change. In my little town of 14,000, the local hospital sees about 180 patients a day. If a woman comes in pregnant and 4 or more cm dilated, the ED physician is expected to deliver the patient, resuscitate the baby and then, and only if they are stable, transfer them to the OB staffed hospital 50 minutes away. There obviously is no OB, no NICU, no backup of any kind. I interviewed there for nights before going FT telemedicine thinking to keep my skills up just in case, but when the chair explained this policy to me, I politely refused. What happens if she's breech? What if there are decels? Are we expected to do a bedside C section? Am I expected to repair that grade 3 vaginal tear? We are not obstetricians. And, trying to do that while running a department with that volume is only asking for trouble. The ED is a high risk place as it is no matter where you work. This, again, should be a national discussion.
At my last full-time ED job, I was presented with a patient fully dilated, -2 station, no prenatal care at a hospital with no OB, Peds, as my first patient of the day. The night guy couldn’t wait to leave. Knowing that the week before, none of the nurses knew what to do when I had a patient who needed a chest tube (I had to find the kit, set up the wall suction, etc.), I contacted an OB at the mother ship; she both refused the patient and wouldn’t come over to help (30 minutes away). I ascertained that it wasn’t a breech, but labor wasn’t progressing. After 30 minutes, I had the ALS unit that had transported her take her to the mother ship hospital (I know, EMTALA, but she was as stable as I could hope). Fortunately, the delivery went well, but I was roundly criticized for the transfer. I asked the PTB what they would have done. Crickets. I decided I was the dinosaur and retired.
What an absolute nightmare. I think that the mentality is, once they’re in our department, they’re our problem and ours alone. Glad you escaped it all.
Horrendous indeed. Yet the bean counters and money bag holders continue to not give a rip. So sad.
I used to work in a small town hospital as a family doctor. (Town was population 10,000) We had OB, but not always in house. So, while I was there at 2 am tending an ICU patient, occasionally the L&D nurse would call over the intercom, “Any doctor in the house to OB stat”. Yikes. Usually that meant I did a fast delivery before the OB arrived to the hospital. That hospital is now closed. Those women have to drive a full hour now to the nearest hospital with ER and OB. Some deliver in the car on the way. Not optimal by any measure.
I was working ER/urgent care one Saturday when our paramedics got called out to a woman delivered at home. She had an abruption of a small for gestational age 37 weeker that was birn by the time the paramedics arrived. Her 10 year old son was the only one home ( husband was at work). Baby and mom turned out fine, dropped her glucose slightly while we waited for the NICU transport team to arrive. Mom and babe went to the hospital with the NICU and were just fine. The paramedics had just reviewed emergency birth procedures and I was studying NRP. Saw mom and babe a few times after, mom still remembers my being there to take care of her baby ( I was a former NICU nurse)
Unless…things…change…the Big, Beautiful Bill is going to be passed and more rural hospitals will close. Why on God’s green Earth are we allowing this to happen?!
I understand your point Jon. But the last administration wasn't exactly fixing rural care either.
I'm not trying to defend the Biden Administration Ed, but what-about-ism aside, and on point, the Trump spending bill will gut Medicaid and thousands of people will lose their access to health care. Small hospitals...mostly in rural areas, will be forced to close. Those seeking urgent/emergency care, including OB, will have to travel much greater distances to receive the care they need at the nearest operational ER/hospital. This will surely put more burden on an already broken system. Physician burn-out is bound to increase. I am no politician or social planner, but the scenario seems grossly predictable to me. If I am walking on a trail and hear the rattle of a pit viper, I usually take a step back and choose an alternate route. Pardon the metaphor, but shouldn't we be doing the same? Before we as a country take the next step, it is lunacy to not have another plan in place... if we truly care about the healthcare needs of our rural and poor urban citizens.
Like but don't like, but what cam an 87 year old person do?