Chapter 2 - Service organization: hospital and departmental

Summary

This chapter provides an overview of hospital and departmental service delivery issues, which hospitals may use in formulating a service for the critically ill parturient. In general, critically ill parturients are cared for in the delivery unit or in an obstetric high dependency unit (HDU); alternatively they may be admitted or transferred to a medical or surgical intensive care unit (ICU). Generally, the HDU may be appropriate for pregnant or puerperal women who are conscious and who have single-organ dysfunction. Ideally, the HDU should be located in or in close proximity to the labor and delivery ward. The HDU physician director and nurse/midwife director can give clinical, administrative and educational direction through guidelines and education of the HDU nursing, medical, and other ancillary staff. Simulation can encompass a large range of activities ranging from basic skills and drills to more sophisticated multidisciplinary training in purpose-built simulation centers.