Subject: Collaborative Care of the Obstetric Trauma Patient Policy
Collaborative Care
of the Obstetric
Trauma Patient
Effective: 08/07/06
Approved: 08/07/06
Policy
No.:600.90
Page: 1 of 3
Approved by: Institutional Trauma Committee
1.0 Philosophy/Purpose:
A. To ensure safe and coordinated care to obstetric trauma patients, the Department of
Emergency Medicine (DEM) & Trauma Team, The Department of Obstetrics and
Gynecology, and The Neonatal Intensive Care Unit Team will provide collaborative
care of Obstetric Trauma patients estimated at 20 or greater weeks, presenting to
Henry Ford Hospital.
B. Communication and collaboration between the Department of Emergency Medicine
(DEM), Trauma, Obstetrics, Neonatology, and Critical Care is essential to assuring
appropriate decisions regarding maternal and fetal well being.
C. Severity of maternal disease process and necessity of critical care interventions will
determine the physical location of the patient.
2.0 Scope:
This policy applies to Henry Ford Hospital campus.
3.0 Responsibility:
It is the responsibility of all staff at Henry Ford Hospital to be aware of and to comply
with this policy.
4.0 Policy:
A. All potentially viable babies will be continuously monitored to the best efforts and
ability of the OB team, depending on the status of the mother.
B. Initial fetal monitoring should commence on arrival of the patient to the resuscitation
room for patients greater than 20 weeks gestation.
C. All 20 or greater weeks pregnant trauma patients meeting Level 1 or Level 2 trauma
criteria will be triaged to the resuscitation room in the ED.
5.0 Process:
A. DEM is pre-notified of a pregnant trauma patient’s impending arrival or a pregnant
trauma patient presents to the ED.
B. All 20 or greater weeks pregnant trauma patients meeting Level 1 or Level 2 trauma
will be taken to the resuscitation room in the ED.
C. The Clinical Coordinator (CC) in the Emergency Department activates a Level 1 or 2
Activation verbalizing that the patient is pregnant at estimated 20 weeks gestation or
more, and relays and information about the patient’s hemodynamic status and
mechanism of injury.
D. The CC in the Emergency Department notifies OB Team of patient arrival or
impending arrival of OB trauma patient. Information should include hemodynamic
Subject: Collaborative Care of the Obstetric Trauma Patient Policy
Collaborative Care
of the Obstetric
Trauma Patient
Effective: 08/07/06
Approved: 08/07/06
Policy
No.:600.90
Page: 2 of 3
Approved by: Institutional Trauma Committee
status, mechanism of injury, estimated time of arrival and estimated gestational age, if
known.
Notification Flow/Tree:
 DEM Clinical Coordinator notifies:
(1) Trauma Team activation
(2) Labor and Delivery (L&D) Charge Nurse (916-0463)
 Labor the Delivery Charge nurse notifies:
(1) OB Attending (916-0465)
(2) OB Resident (916-0742)
(3) Neonatal Intensive Care Unit Neonatal Nurse Practitioner (916-0467)
E. Each team member or designee will report immediately to the ED resuscitation room.
F. The OB Team, upon arrival to the DEM, will assess fetal gestational age via
ultrasound, and then initiate continuous fetal monitoring, if indicated.
G. A fetal monitor will be placed on all patients with an ultrasound estimated gestational
age of 22 weeks or greater.
H. Fetal monitoring will continue throughout the patient’s diagnostic evaluation in the
DEM with continuous presence of a Labor and Delivery RN.
I. The patient’s disposition (OR, L&D, ICU) will be determined by the Trauma
Attending Physician.
J. The Trauma Attending or designee is responsible for contacting the OB Attending and
the Labor and Delivery RN caring for the pregnant patient with the information
regarding the patient’s disposition.
K. Consultation of OB patients less than 22 weeks gestation will be at the discretion of
the Trauma Attending.
L. If patient requires immediate surgery, the Obstetric and Trauma teams will jointly
assess the need for fetal surveillance before, during and/or after surgery.
M. The OB team will notify the Labor and Delivery charge nurse and the NICU team of
the impending delivery.
Subject: Collaborative Care of the Obstetric Trauma Patient Policy
Collaborative Care
of the Obstetric
Trauma Patient
Effective: 08/07/06
Approved: 08/07/06
Policy
No.:600.90
Page: 3 of 3
Approved by: Institutional Trauma Committee
N. If the patient is not delivered, but requires admission to an in-patient unit (ICU/GPU)
or Labor and Delivery, the OB team will assess the need and frequency of fetal
monitoring during the hospitalization.
(1) If continuous electronic fetal/uterine monitoring (EFM) is required, an L&D
RN will accompany the patient to the ICU/GPU to set up the fetal monitor and
remain with the patient for on-going evaluation of fetal/uterine status.
(2) If intermittent fetal/uterine monitoring is required, the OB Attending or OB
Resident will notify the L&D Charge Nurse of the specific orders.
O. The “Obstetric Off-Service Tracking Log” will be initiated on Labor and Delivery for
pregnant patients admitted to in-patient units other than Labor the Delivery and
Family Centered Maternity Care who require fetal/uterine evaluation.
P. Patients admitted to Labor and Delivery or Family Centered Maternity Care will
follow the standard of care for uterine/fetal surveillance as indicated in HFHS policies,
care guidelines and unit specific protocols for the pregnant patient.
Q. Prior to discharge of any patient with a viable pregnancy greater than 22 weeks
gestation, the patient must be cleared by both the Trauma Service and the OB Service.
6.0
Recommended Compliance Monitors and Audits: Trauma Center QI Program
7.0
References/Sources: Crit Care Med 2005 Vol. 33, No. 10