Reply To: policy for FHR for early gestation pregnancy

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Here is what we have:

Unscheduled OB Patient: Any obstetric patient who presents to the hospital (Emergency Department or Labor and Delivery) unannounced, unplanned or unanticipated. Regardless of whether the patient has an attending physician or a preregistration account, or whether the physician has notified Labor and Delivery that the patient is coming, the hospital will provide a medical screening exam and any necessary stabilizing treatment.
Scheduled OB Patient: An obstetric patient who is prescheduled for a cesarean section, induction of labor, nonstress test, or other outpatient procedure (such as a version or amniocentesis). The scheduled OB patient’s care is not governed by EMTALA regulations.
A. The unscheduled OB patient is greeted by Labor and Delivery staff and is taken immediately to a treatment room, where she is greeted by the obstetric RN/QMP. The HUC may ask basic information to register the patient, such as name and date of birth, but this cannot delay the nurse’s assessment and care of the patient.
B. The obstetric RN/QMP performs the following assessment and medical screening exam for labor status:
1. Initial maternal vital signs, maternal history, and physical assessment including contractions and cervical dilation as appropriate.
2. Assessment of fetal well-being by Doppler or external fetal monitor.
3. Completion of the Obstetric Medical Screening Tool, calculating the initial assessment score. See Obstetric Medical Screening Tool.
C. The RN/QMP notifies the physician of the results of the Obstetric Medical Screening Tool and any other pertinent data gathered during the assessment and implements physician orders as directed.
D. If the patient is to be observed and discharged, the RN/QMP will conduct another assessment and calculate the discharge assessment score after the observation time has lapsed. The nurse will notify the physician of the discharge assessment score before the patient’s dismissal from the unit.
E. If the patient is not in labor and her chief complaint remains, the patient’s physician can come and evaluate the patient or give orders to transfer the patient to the Emergency Department for a medical screening exam and further treatment.
F. Any patient who is discharged to home while still pregnant will receive information about when to return to the hospital or contact her care provider in the Antepartum Discharge Instructions.
G. If the physician orders a transfer for the patient, the certificate of transfer is completed by the RN/QMP and is countersigned by the attending physician within 24 hours.

Department of Health and Human Services Centers for Medicare & Medicaid Services. (May 29, 2009). Revisions to Appendix V, “Emergency Medical Treatment and Labor Act (EMTALA) Interpretive Guidelines”. CMS Manual System, Transmittal 46. Retrieved 11 Nov 2015 from: