Renown Women's Health Medical Group
University of Nevada, Reno School of Medicine
Family Medicine Resident Program
Renown Regional Medical Center
These guidelines are intended to facilitate assigning, attending and following up on unassigned obstetrical patients that come to Labor and Delivery, and to maintain intra-partum and postpartum continuity of care for such patients.
Four subsets of Walk-ins are listed below. All are assumed to be at least 20+s weeks gestational age, or of a gestational age felt to be better served on Labor and Delivery.
Upon admission to triage or Labor and Delivery under the Renown Women's Health OB/GYN Physician on call (face sheet), the initial call from the L & D or Triage Nurse should go to the Family Medicine senior (PG 2 or PG 3) resident on call for the Family Medicine Hospital Service.
The resident is expected to respond to the call in a timely manner and perform a bedside H & P, as soon as possible. (Of course imminent deliveries, emergencies, or timely order issues may be directed to the OB/GYN on call)
Type 1: Patient at or near term, in labor, and needing delivery this hospitalization
The resident is expected to manage and take responsibility for the patient, under the supervision of the OB/GYN faculty, throughout the L & D process.
For postpartum care of vaginal delivery patients, the Family Resident, under the guidance of the OB/GYN faculty is responsible for rounds and follow-up. The chart should clearly be labeled "Renown's Women's Health".
Type 2: Not in labor, not requiring admission, but needing an evaluation and outpatient follow up (OB check)
The resident is expected to make arrangements for appropriate work up and appropriate follow up under the supervision of the OB/GYN faculty. This would include any/all prescriptions, and clear instructions for the patient to follow-up in Family Medicine Continuity Clinic or Renown Pregnancy Center. If the patient resides outside of the Reno/Sparks area, every effort should be made to arrange for such services with an appropriate provider near the patient's residence.
Type 3: Not in active labor and requiring admission/observation for an obstetrical complication, but not likely to deliver in the next 24 hours (such as bleeding, preeclampsia, SROM, rule out pre term labor).
The resident should complete the admission history and physical and admission orders under the supervision of the OB faculty. After consultation with the OB faculty, the resident and OB faculty will determine whether the patient will be admitted for delivery or obstetrical intervention. If not, the patient will be discharged to an outpatient clinic such as the family needed, the patient will be followed and managed by Renown Women's Health OB/GYN faculty on call. If discharged and stable the patient may be seen at either Family Medicine or the Pregnancy Center.
Type 4: Not in labor but requiring admission for a non-obstetrical problem (such as pyelonephritis, gallstones or renal stones).
The resident should complete the admission history, physical and admission orders under the supervision of the family medicine faculty. The patient then will be the responsibility of the family medicine hospital team supervised by the family medicine faculty member for subsequent care. Consultation with the OB/GYN faculty will be requested and performed as necessary.
School of Medicine Family Medicine OB-Continuity Clinic patients are admitted under the Family Medicine Faculty member and followed and managed exclusively by the resident assigned to the patient. For delivery it is expected that the Family Medicine Faculty will be in attendance to assist the resident.
If the faculty member is unavailable or the delivery is imminent, the Renown Women's Health OB/GYN on call will assist the resident or perform the delivery. As these patients are assigned to the Family Medicine Clinic, they will be followed in the postpartum period by the family Medicine Service, even if a Cesarean Section is required.