Streamline paperwork and improve OB stays

Preadmit visits make more time for patient care

Don’t you hate to pester new moms with itpicky questions like the fathers’ Social Security numbers because no one remembered to ask when they checked in? Here’s how one obstetrics unit solved the problem without add-ing staff or chalking up overtime.

Staff in the obstetrics unit at Portage Health System’s Portage Hospital in Hancock, MI, figured that if women came in for lab work two days before scheduled C-sections, why not do something similar for all deliveries? Obstetrics unit manager Trudi Huls, RN, BSN, says planning took four months, and the unit spent another three months ironing out the wrinkles. The program is now a year old.

The first preadmission appointments lasted 11¼2 hours. "That’s too long for a pregnant woman to sit still," says Huls, "and it’s a big chunk out of our day." Maximum staffing on the unit is two RNs and one certified nurse aide per shift. It fluctuates according to the caseload. After slotting two preadmission visits into each day and evening shift, they scaled back to one each. That allowed flexibility for staff to attend women in labor.

Early on, Huls learned how to structure the preadmission visit to simplify admission procedures and to enhance the quality of care during the mother’s hospital stay.

How to succeed

Here are keys to the program’s success:

• Gather all routine information for the birth certificate, such as the mother’s maiden name and, if the couple is unmarried, whether the father will sign the paternity papers.

• Discuss home care plans to ensure that mother and child will have support during their first two days at home.

• Review basic neonatal care for first-time mothers.

• Remind women that they can call or visit to pre-register at the hospital admitting department. That’s one less stop to make when they check in for labor and delivery.

• Advise expectant moms to call they unit before they come in for delivery. "Then, we’re all ready for them when they get here," Huls says.

• Explain which hospital entry to use for day and night admissions.

• Provide a packet with information such as personal items to bring for the hospital stay, visiting hours, and postpartum instructions. (A copy of Portage Hospital’s postpartum instructions is inserted in this issue.)

To accomplish the most during the one-hour visit, Huls urges mothers to come alone. "When they bring little ones, they get distracted watching them," she explains.

She discourages the presence of husbands and boyfriends at preadmission visits "because we ask about physical and emotional abuse. Some-times we just know there is a problem, but the woman won’t say anything when the man is there. "If the woman admits to being abused, unit staff file a report with the county social services department and refer women to a local shelter for abused women.

Physician cooperation, another key to success, crystallized as soon as the office nurses recognized the value of preadmission visits. "We visited all our doctors’ offices to introduce the preadmission program," Huls says. "But when we had to call the office nurses for something like a patient’s home phone number that they forgot to put on a history, they started to support the program."

Office nurses tell expectant mothers to go to the OB unit in their seventh month. The nurses then fax patient progress sheets from the final prenatal office visits to the unit.

With 350 to 400 births a year, Huls notes that her staff’s workload can fluctuate between hyperbusy and downtime. Preadmission visits even the pace. By scheduling patients within two months of their expected delivery dates, there’s the latitude of rescheduling if necessary, but that seldom happens.

To make preadmission visits as convenient as possible, Huls coordinates them with a prenatal office visit she arranges with the office nurses. Because the community is rural, such accommodations are especially important, she says, noting that some women drive 80 miles for medical visits.

Preadmission visits also improved the quality of the hospital stay, Huls says. "Our patients like being able to rest and spend more time with their babies. We get to do more teaching."

The program enjoys great popularity among patients. In fact, Hulls says, "If we happen to get behind in scheduling, patients will call us and say, ‘What happened? I didn’t get my appointment?’"

At St. Mary’s Hospital in Reno, NV, preadmission visits improve staffing, but in a different way. The visits are handled by the hospital’s admission department, which frees the clinical staff to deliver 250 babies a month. Jackie McFalls, RN, MS, nurse manager of the hospital’s Family Care Center, relates that expectant mothers come in two to three months before their due dates. They learn about the preadmission policy through the hospital’s prenatal classes.

OB technician Kelly Gregory says, "This arrangement is much better for us. We would have to have more staff if we took care of registration ourselves."