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Based on record review, policy review, on call schedule and staff interview, it was determined that the facility failed to ensure the services of the obstetrics physician on call were available when needed for 1 (#1) of 20 patients. See A 2404.

Based on record review, physician on call schedule, policy review and staff interview, it was determined the facility failed to ensure the physician on call for Obstetrics specialty care was available for care of 1 (#1) of 20 sampled patients. This practice lead to a delay in obtaining obstetric care and an unattended delivery of a premature baby in the Emergency Department.


Findings include:

Patient #1 was admitted to the facility's ED on 4/20/12 with the chief complaint of vomiting and low abdominal stabbing pain. She was pregnant with a due date of 5/25/12. Review of the medical record revealed that a medical screening examination was initiated by the Physician's Assistant at 4:54 p.m. on 4/20/12 and reviewed by the ED attending physician. Documentation revealed that the PA documented the patient's chief complaint was intractable vomiting and dehydration. He also noted she was pregnant. Her ordered boluses of intravenous (IV) fluids, Zofran and Reglan. He also determined the patient had a urinary tract infection and ordered rocephin. At 7:00 p.m. he noted the patient should be monitored in OB. Nursing documentation revealed the OB nursing director had assessed the patient and indicated she had felt contractions. The PA documented a consult order at 6:19 p.m. for the OB physician on call. Review of the record of notification of the consult revealed the initial page to the physician on call was made at 6:23 p.m. This was followed with pages at 6:37 p.m. The physician's partner was paged at 7:12 p.m. At 9:00 p.m., the physician, who was on call returned the call. The nursing documentation revealed the patient self-delivered a 4.5 pound male baby at 8:30 p.m., unattended in the ED examination room.
The PA was interviewed on 4/30/12 at approximately 3:00 p.m. He indicated that he and the ED physician wanted to discuss the patient with the OB physician on call before transferring her to the OB department. The facility's Medical Staff Rules and Regulations require that the on call physician to respond within 30 minutes of the call. The Risk Manager and CNO indicated that the failure of the OB physician to respond to the page resulted in a delay in moving the patient to the OB unit. This issue is being addressed by the Medical Executive committee.
Review of the physician on call schedule revealed that the physician who was paged was the physician who was on call on 4/20/12.