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Hey guys,
I work at a community hospital and as one of my duties as Quality Chair I am the liaison to the OB department. For years, our hospital has shipped out patients with severe pre-eclampsia requiring greater than a certain dose of labetolol for BP control to a tertiary facility. One of the OBs is frustrated with this because she has to ship out these patients (and subsequently lose the revenue) and wants the anesthesiologists to place arterial lines and manage IV antihypertensives like Nitroprusside or Nicardipine on the OB floor with an ICU nurse coming down to manage the infusion under our care. I am willing to help place the arterial line but I feel managing the infusion would be inappropriate since it is basically making me into an intensivist when I have other responsibilities on OB (epidurals/C-sections/etc.) and I don't want that liability. In my opinion, she is the primary physician for the mother and should be responsible for this, especially since she is also giving other meds which have an effect on the patient's blood pressure like magnesium. When I asked her why she doesn't want to manage the antihypertensive infusion, she said she has not trained in it and would be uncomfortable. That seems like a weak argument. I can give her a 5 minute Powerpoint presentation and "train" her on basic infusion rates. She is hesitant to have these women deliver in the ICU because the infrastructure to monitor the baby is not in place up there but that may be an option if the intensivist is willing to go along (the docs are not in house at night generally so I don't know if they would be willing to as well). I know I can bill for an arterial line (a whopping $60) but can a non-intensivist bill for vasodilator management separate from the primary OB physician? Does anyone have experience with this kind of setup at their COMMUNITY hospital (not some fancy tertiary facility with a dedicated OB ICU)?
Thanks for the responses
I work at a community hospital and as one of my duties as Quality Chair I am the liaison to the OB department. For years, our hospital has shipped out patients with severe pre-eclampsia requiring greater than a certain dose of labetolol for BP control to a tertiary facility. One of the OBs is frustrated with this because she has to ship out these patients (and subsequently lose the revenue) and wants the anesthesiologists to place arterial lines and manage IV antihypertensives like Nitroprusside or Nicardipine on the OB floor with an ICU nurse coming down to manage the infusion under our care. I am willing to help place the arterial line but I feel managing the infusion would be inappropriate since it is basically making me into an intensivist when I have other responsibilities on OB (epidurals/C-sections/etc.) and I don't want that liability. In my opinion, she is the primary physician for the mother and should be responsible for this, especially since she is also giving other meds which have an effect on the patient's blood pressure like magnesium. When I asked her why she doesn't want to manage the antihypertensive infusion, she said she has not trained in it and would be uncomfortable. That seems like a weak argument. I can give her a 5 minute Powerpoint presentation and "train" her on basic infusion rates. She is hesitant to have these women deliver in the ICU because the infrastructure to monitor the baby is not in place up there but that may be an option if the intensivist is willing to go along (the docs are not in house at night generally so I don't know if they would be willing to as well). I know I can bill for an arterial line (a whopping $60) but can a non-intensivist bill for vasodilator management separate from the primary OB physician? Does anyone have experience with this kind of setup at their COMMUNITY hospital (not some fancy tertiary facility with a dedicated OB ICU)?
Thanks for the responses