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Archive for the ‘OB/GYN’ Category

GYN disposition

A little helpful information for obtaining f/u for your gyn patients who need to be seen soon (days to weeks)

1. Choose category misleadingly labeled “GYN follow-up within 1 month”

a. Patient will be seen in a range of 2 days to 1 month based on the clinical issue

2. Please be specific about what the clinical issue is (i.e. “needs evaluation of post menopausal bleeding”, or “follow-up after I and D of Bartholin Cyst”)

a. See 1a above- if you don’t write it, they don’t know why you are requesting rapid follow-up

3. If you are able- put the patient’s cell phone # in the request or document in the chart

a. The follow-up can only be arranged if the clinic can contact the patient

b. Patients may not give correct phone # at registration because of billing concerns

Our colleagues in gyn want to provide good service (appropriately time follow-up) for patients with gyn complaints but need your help- steps 1,2, and 3 above to facilitate.

Thanks,

Luke

Written by phil

January 24th, 2013 at 4:17 pm

OB GYN Follow Up

1. Based on ACEP’s recent clinical policy (ask Sigrid) the use of a “discriminatory threshold” to guide decision making in pregnant patients without a visible IUP on bedside sonography is no longer advised.

a. A serum beta < the threshold does not decrease the likelihood of an ectopic b. A serum beta > the threshold does not increase the likelihood of an ectopic

c. So… if no bedside IUP visible get an official sono (regardless of any serum beta level)

d. If no IUP visible on official sono have a low threshold for involving gyn

2. We need to clarify our terminology regarding early pregnant patients (only two common diagnoses):

a. Presents with relevant complaint and has IUP-

i. discharge as threatened miscarriage-

ii. follow-up is 1-2 weeks in new OB clinic and be sure to set patient expectations appropriately (i.e. you are not sending them to the specialist who is going to do a procedure to save the pregnancy- the OB folks can’t do anything for this population except provide reassurance)

b. Presents with relevant complaint and no IUP found-

i. Diagnosis is possible ectopic

ii. Low threshold for involving Gyn (regardless of serum beta level)

iii. If discharged should follow-up in Gyn Urgent clinic (or return to ED)- be sure you indicate in the referral that ectopic is a concern

c. Gyn Urgent Clinic is for patients who need to be seen in less than a month:

i. Patient will be triaged by a provider based on information you put in the request

ii. They want you to document your concern and specify a desired follow-up period (i.e. bleeding fibroids with low HCT- given OCP taper- needs to be seen within 1 week)

d. Gyn Non-urgent is for patients who can be seen in 4-6 weeks (or perhaps not all)…

Thanks,

Luke

Written by phil

October 26th, 2012 at 4:29 pm

Posted in OB/GYN

Products of Conception

with 3 comments

there is a mandatory DOH form that MUST be filled out for any products of conception – either delivered in the ED or brought into the ED by the patient. the form is attached to this email for your review & will be available from “my dashboard” within epic. we also plan to have the form rubber banded to the formalin containers. the form must be returned to suzanne young-mercer on its completion.

Vaishali Patel

note from reuben: please be wary of determining that anything coming from the uterus of a pregnant woman is products of conception. calling such tissue POC when it isn’t, therefore inaccurately ruling out ectopic pregnancy, is an important pitfall. unless the “products of conception” have the unequivocal form of a human, they may not be products of conception, and ectopic might still be in the differential. unless clearly POC, send it to pathology and procede in a “pregnancy of undetermined location” mindset (unless the pregnancy has been proven to be intrauterine in the past). you can follow the path, and if chorionic villi are noted, you can call the patient and tell her that ectopic pregnancy has been excluded and if everything else is well, she can skip the 36-48h followup and follow with her obstetrician as a routine.

Spontaneous Termination of Pregnancy Form

Written by reuben

September 2nd, 2011 at 5:09 am

Posted in OB/GYN

Pregnancy Status Documentation

The Hospital Staff Rules and Regulations, Section on History and Physical was amended to include:
 
·         Pregnancy status must be documented on all patients of child bearing potential within 24 hours of admission and prior to any diagnostic or therapeutic procedures. 
·         Refusal of pregnancy testing must be documented, as applicable.  
·         Adult patients refusing pregnancy testing may sign a “Refusal of Pregnancy Testing and Release” form, which is available on the Intranet, section on the Consent Policy. 
·         If a Pediatric patient requires care, please call the Adolescent Health attending physician on-call.
 
To find the revised Rules and Regulations on the Intranet copy this address: http://intranet1.mountsinai.org/admin_policies/rules_regs/frame_RR97.htm

Written by phil

July 14th, 2010 at 5:31 pm

Posted in OB/GYN

OB Policy

Written by reuben

September 16th, 2008 at 10:13 pm

Posted in ED Guidelines,OB/GYN

OB/GYN Follow Up

First Trimester Bleed/Ectopic Precautions
Call ext 47238 and leave the following information:
1. Last and first name, date of birth and the medical record number of the patient.
2. An active telephone contact.
3. The time range that the patient should be scheduled for follow-up care.

Other Indications for Referral to OB/GYN
Pregnancy
Dysfunctional uterine bleeding (H/H>30)
Post-partum patients
Vaginitis
Urinary tract infection
Pelvic inflammatory disease
Sexually transmitted diseases
Contraception (all forms)
Routine Gyn exam
Pelvic pain

Refer to Specialty Clinics
Colposcopy (Abnormal PAP) -> Pt with abnormal PAP smear
Menopause
Cystometrics (Urinary Incontinence) Speciality clinics

Refer to JMF Clinic not GYN
Sexual assault patients

Refer to Gyn Surgery Clinic
Bartholin cyst/abscess (1 week//use Word Catheter)
Ovarian cyst premenopausal pt (>5 cm) (1-2 wk)
Ovarian cyst postmenopausal pt (any size) (1-2 wk)
Pt requiring elective surgery (1-2 wk)
Fibroids(symptomatic or >12 wk) [3-4 wk; If H/H <30, w/in 1 wk] DUB unresponsive to treatment [3-4 wk; If H/H <30, w/in 1 wk] Cysto/rectocele 3-4 wk (needs neg urine C&S) Uterine prolapse 3-4 wk Other Gyn pathology 3-4 wk Refer to Infertility Clinic Infertility Gyn endocrine disorder OB/GYN Consultation:

Written by phil

August 17th, 2008 at 12:00 pm

Posted in OB/GYN