In house obstetricians and epidural placement

[martinri23]

For those in private practice:

How long does an obstetrician have to remain in-house or be readily available after placement of an epidural? I am curious as most hospitals I have worked at require 24hr in house OB attending coverage. At my current hospital, this was also the case until recently when the obstetricians began rebelling against the administration by not taking these poorly paid in house OB calls. This has led to several instances of requests for epidural placement when no OB was readily available. I have tried searching ACOG, and SOAP for guidelines referencing this matter and can not find anything that addresses this issue.

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[chocomorsel]

At my last gig, they had to be there for the placement of the epidural. Once it was in, and the patient was deemed stable by the anesthesiologist, the OB could go home.
I don't know the ACOG guidelines and thankfully don't do OB anymore.

 

[Wiscoblue]

Our OBs are at home in bed when we are placing the epidural at night. Then we go home after we place it.


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[PainDrain]

We have in house OB coverage for all laboring patients. I don't think there is anything saying that they have to be in house by ACOG guidelines but the 30min decision to incision standard means they have to be close by. I personally wouldn't place and epidural and then go home but that is standard some places.

 

[vector2]

For those of you that go home after placing epidurals, does the OB nurse just call you when bolusing or changing the infusion rate is required?

 

[neuroride]

Same here at Wiscoblue and yes the OB nurses call for boluses issues though we use PCEAs which work well to cut down on calls

 

[Consigliere]

Our CRNAs place labor epidurals and stay in house until the pt. delivers. The OBs are all within 15 minutes of the hospital. I stay in bed - ain't nobody got time for that!

 

[Wiscoblue]

For those of you that go home after placing epidurals, does the OB nurse just call you when bolusing or changing the infusion rate is required?

Our orders are such that it gives the Ob nurse some leeway to adjust the infusion. We also have a 5 cc pcea bolus

 

[Shouldawouldacouldas]

You can't find it on ACOG because if they put too many 'guidelines' concerning in-hospital requirements, then it would be very difficult for rural hospitals to meet the standards.

I work at a less than 200 bed hospital in a rural but not underserved area.
We put in epidurals when the OB wants it. In PP, anes is a service. Of course, our OB's are reasonable, and they will 99.9% defer to our judgment if there is an issue. Because we accommodate surgeons and hospitalists so much, they listen and 99.9 % follow our wishes if there is a pt safety issue. Also, in PP, no physician wants complications.

Our OB's usually are in hospital. We do not care if they are there or not. It is not required for OB's to be in house for epidural placement. Our town is small enough that if they are at a near by restaurant, it takes about 6 minutes to drive to the hospital.

We, anesthesiologists, place epidurals and leave after pts are comfortable and stable. Our billing company bills for our short time. Some insurances pay a set price and some pay per time. We live 6-8 minutes away. The only time we have to stay in hospital are VBAC's. The entire OR team and anes must stay in hospital until the VBAC is delivered. The only group not in hospital for VBAC's are the pediatricians.