To provide a consistent system for the evaluation of presenting women with pregnancy-related issues in compliance with federal EMTALA requirements.
It is the policy of this hospital to provide a medical screening examination to all patients presenting for unscheduled obstetrical evaluation, testing or services within the capabilities of the Obstetrical Unit and the ancillary services routinely available to the Obstetrical Department, including the use of on-call physicians. Patients 20 weeks gestation or greater, with obstetrical or gynecological presentations (other than for scheduled procedures) will receive a medical screening examination in the Obstetrics Department consistent with this policy. Patients fewer than 20 weeks gestation will be provided a medical screening examination in the Emergency Department. Where trauma and/or medical conditions that are emergency medical conditions are present in the pregnant patient, the patient will be assessed in the Emergency Department and the location of further assessment and treatment will be at the medical discretion of the Emergency Department physician.
- All patients presenting for obstetrical and gynecological conditions, other than scheduled procedures, will be logged in by the Emergency Department, or directly in the Obstetrics department, if they present there initially.
- Patients with less than 20 weeks estimated gestation will be evaluated in the Emergency Department following the Emergency Department patient screening policy.
- Patients with 20 weeks or greater estimated gestation will be evaluated in the Obstetrics Department following initial log entry in the Emergency Department. The patient shall be transported to the Obstetrics Department by wheel chair or gurney by an Emergency Department nurse. An Emergency Department record will be created on the patient, with at least name, date of birth, time of presentation, estimated gestation and presenting complaint noted. The record shall state the patient was transferred to obstetrics by wheel chair [or gurney], the name of the nurse accompanying the patient, the time of the transfer, and the time of arrival in the Obstetrics Department, together with any medically relevant observations, vital signs, and interventions.
- All patients reporting for evaluation will receive at least the standard obstetrics evaluation indicated by the Obstetrics Evaluation form and performed by a qualified evaluator. Patients requesting a "labor check" or asking to be evaluated for their ability to reach another facility must receive the standard evaluation, unless they refuse evaluation in writing on the refusal of services form. Download Obstetrics Evaluation form
- The obstetrics evaluation will be conducted in segments as follows:
- The initial evaluation will include the determination and documentation of all items indicated by the Obstetrical Evaluation form.
- EXCEPTION: Patients less than 35 weeks gestation and without uterine contractions will not receive vaginal examinations. Patients with ruptured uterine membranes will not receive vaginal examinations except on the initial and final examinations.
- At approximate 30-minute intervals, two additional physical assessments will be performed, unless the patient's progress into labor or distress obviates the need for further assessment prior to the admission decision.
- The patient will be scored as indicated on the Obstetrics Evaluation form and the patient will be given a score at the conclusion of the each exam and the score noted. Where data blocks are shaded, use the last value obtained for that item for the purposes of scoring.
- Patients receiving a score on ANY examination that indicates that the patient must be seen by a physician or nurse midwife must be seen by a physician or nurse midwife without awaiting further interval scoring. Where the patient is expected to deliver immediately, the Obstetrics Evaluation form need not be completed in its entirety, but initial observations should be logged to the form.
- When the results of any scoring indicates that a physician exam is required, or upon the request of a nurse evaluator, the patient's attending physician or the on-call obstetrician shall personally examine the patient for the purposes of completing the medical screening examination.
- Attending private physicians are bound by the same timely response requirements as on-call specialists for the purpose of securing a physician examination. In the event that the private physician fails to present in a timely manner, the on-call specialist will be contacted by nursing staff to perform the physician examination.
- Patients with 6 or fewer points in Block C, with no physician exam required by Box A or Box B after evaluation by a non-physician Qualified Evaluator may be discharged upon telephone orders from the private attending physician or on-call specialist. A copy of the written discharge instructions provided to the patient shall be included in the medical record, signed by the patient, and signed, dated and timed by the nurse providing the discharge instruction.
- All phone contacts with the attending or on-call physician shall be noted and timed in the record.
- Patients, after examination by a physician or nurse midwife as indicated by the scoring criteria, may be discharged upon the written order of the examining physician or nurse midwife, if:
- delivery is not expected in the next 6 hours; and
- discharge poses no likelihood of material deterioration in the condition of the mother or fetus; and
- discharge does not pose a threat to the health or safety of the mother or fetus.
Any patient discharged under this provision shall be given written discharge instructions. A copy of the written instructions shall be included in the medical record, signed by the patient, and signed, dated and timed by the nurse providing the discharge instruction.
- Pertinent nursing observations other than those provided in the Obstetrics Evaluation form and nursing care provided shall be documented on a standard patient record form. Physician orders shall be documented in the standard medical record.
- In the event that the patient is discharged prior to delivery, the medical record shall contain the time of discharge, the vital signs of the patient and fetus at discharge, and the labor status of the patient at discharge, and the written or verbal orders of the physician shall be documented in the record..
- No patient with a score of 7 or more after examination by a physician or nurse midwife, nurse practitioner, or Physician assistant, shall be transferred, referred, or directed to any other facility, except for care not available at this hospital or by reason of patient initiated transfer or departure Against Medical Advice, as provided in the Patient Transfer Policy of this hospital. All transfers, directions or referrals will comply with the Patient Transfer Policy. Patients with a score of 7 or more are deemed unstable for the purpose of transfer procedures.