HospitalInspections.org

Based on interview, medical record review and facility document review, it was determined the facility failed to meet standards for state licensure noted in the regulation referenced below:
12VAC5-410-441. Obstetric Service Requirements; Medical Direction; Physician Consultation and Coverage; Nurse Staffing and Coverage; Policies and Procedures.
U. The governing body shall adopt written policies and procedures for the management of obstetric patients approved by the medical and nursing staff assigned to the service.
1. The policies and procedures shall include, but not be limited to, the following:
n. Staff capability to perform cesarean sections within 30 minutes of notice;
The findings include:

Review of the medical record for Patient #3 revealed the following: Patient #3 was admitted to the hospital in active labor on 4/2/16 at 9:13 AM after a failed home delivery with midwife guidance. Patient #3 was assigned to the service of Physician #2 a family practice physician with obstetric privileges for management of normal and emergent labor and delivery.

Patient #3 remained under the care of Physician #2 and continued to labor until 3:17 PM when an emergency C-section (cesarean section) was called by Physician #2 due to "failure to progress, Meconium (first feces of a newborn) stained fluid and none reassuring fetal heart tones."

The physician on call for cesarean section deliveries on 4/2/16 was Physician #1. A progress note entered by Staff #9 at 3:17 PM "Stat c section called via 77777. Trying to reach (name of Physician #1) via phone/text, called (name of Staff #11) to try to reach (name of Physician #1)".
Operating room nursing notes documented the arrival of Physician #1 as 1601 (4:01 PM) with uterine incision and delivery of baby at 1602 (4:02 PM).

In an interview with Physician #1 on 10/12/16, when asked about his/her response time for the emergency cesarean section, Staff #11 stated that he/she was on call and at home about 27 miles away and missed hearing the phone ring a couple of times, maybe 5 minutes before he/she answered the call to come in. Physician #1 reported he/she was on the way to the hospital and was stopped by the police for speeding, who after hearing why he/she was speeding didn't issue a ticket but warned the physician to "comply with every single law" and the policeman "followed behind to make sure I didn't speed" or break any other traffic laws, The physician stated he/she arrived at the hospital, the patient was on the table and he/she immediately did the C-section. The physician stated "I would have been in-house (in the hospital) if I had been given a heads up of the patient with ruptured membranes and meconium staining".

On 10/12/16 at 12:10 PM, an interview was conducted by the survey team with Staff #2 and Staff #9. During the course of the interview it was confirmed by Staff #2 and Staff #9 that the medical record contained documentation by multiple staff members regarding the notification of Physician #1 of the need for an emergency caesarean section with conflicting times noted. Staff #2 validated that in the hospital's review of the case the "decision" time the emergency caesarean section was called for would be 3:17 PM with incision time of 4:02 PM and this would fall out of the required 30 minute timing from decision to incision. (Surveyor calculated there were 45 minutes from decision to incision.)

Staff #2 stated that based on the hospital's review of this case changes have been made related to how obstetrical patients presenting without an assigned physician would be handled in the future. Staff #2 stated "if we receive a patient that has been a patient of a community midwife with a failed home birth, or who has only been under the care of a community midwife or any other patient that through assessment has been deemed "high risk" they will automatically be assigned to the OB/GYN specialty group regardless of who is on call. Staff on OB (obstetrics) unit have been in-serviced on this. The policy defining this has not been finalized but is in process."

Review of the facility document entitled "Cesarean Section Stat/Urgent" revealed the following statement under the heading "1. Categories for timing STAT Cesarean Sections: STAT From time of the decision to time incision will be within 30 minutes for surgery to meet standards."

The failure by hospital staff to perform cesarean sections within 30 minutes of notice was discussed for a final time with Staff #2 on 10/12/16 at approximately 5:00 PM. No further information was provided to the survey team.

Complaint deficiency.