1. Admission Criteria Leadership Randall Morgan MD MBA
Track 2 July 5, 20121
Admission Criteria
Leadership
Randall Morgan MD MBA

2. Admission criteria nulliparous term singleton with intact membranes
Regular painful contractions
4 cm
Fetal assessment-reassuring

3. Review of June track 2 call learning from PC-02
Early labor admission (< 4cm) for nulliparous singleton term vertex associated with unintended consequences:
Higher use of oxytocin (>2 fold)
More post partum hemorrhage (2-4 fold increase with oxytocin)
Increased rate of cesarean (2- 3 fold)
More sepsis

4. Review of June track 2 call learning from PC-02
Unintended consequences for planned cesarean for breech vs. planned vaginal birth of vertex infant associated with unintended consequences:
Increased deep vein thrombosis (2 fold)
More hysterectomies for bleeding (2 fold)
More major puerperal infection (3 fold)
Less hemorrhage requiring transfusion (1/2)
Higher incidence of cardiac arrest & anesthetic complications (2-5 fold)

5. Term spontaneous labor Laughon “Using A Simplified Bishop Score To Predict Vaginal Delivery” April 2011 OB GYN

6. Admission criteria nulliparous term singleton with intact membranes
Regular painful contractions
4 cm
Fetal assessment-reassuring

7. Learning From PC-02 What will encourage learning?
What will discourage learning?

8. Beliefs Perceptions Attitudes Behavior Values Practices NSTV
Labor augmentation
C/S rate
Behavior
Perceptions
Attitudes
Beliefs
Values

9. Perceptions influencing labor diagnosis and admission
Perception is the process by which organisms interpret and organize sensation(s) to produce a meaningful experience of the world.
Point of view

10. Beliefs influencing labor diagnosis and admission
conviction of the truth of some statement or the reality of some being or phenomenon especially when based on examination of evidence

11. Attitudes influencing labor diagnosis and admission
is a mindset or a tendency to act in a particular way due to both an individual’s experience and temperament

12. Term induced labors Laughon “Using A Simplified Bishop Score To Predict Vaginal Delivery” April 2011 OB GYN

13. Term induced labors Laughon “Using A Simplified Bishop Score To Predict Vaginal Delivery” April 2011 OB GYN
RJM
Perception
1. Favorable cervix more apt to deliver vaginally
2. Distinguishing early labor vs false labor difficult
3. Once a patient is admitted with a diagnosis of labor, a certain cascade of events follow that is independent of the accuracy of the diagnosis of labor
4. Misdiagnosis of labor & treating false labor as labor increases chance of unintended consequences just as induction of unfavorable cervix does
Belief
1. Do no harm
2. My practice should minimize and prevent unintended consequences
2. Attitude
1. If I admit for labor I should plan to deliver vaginally
2. Management of elective delivery should not increase the chance that the mother or baby will have unintended consequences

14. What does this statement reveal about:
Statement made by physician regarding G1P0 41 4/7ths who was 1 cm, 50%, -3, vtx with irregular contractions
“We’ll keep her and start oxytocin because that is what we’re going to do in 2 days anyway”.
What does this statement reveal about:
Perceptions
Attitudes
Beliefs

15. How will you create and test admission criteria?

16. How can you test admission criteria for nulliparous term singleton with intact membranes
Regular painful contractions
4 cm
Fetal assessment-reassuring