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52 CURRENT STATUS AND GOALS OF THE COMMUNITY HOSPITAL PERINATAL SERVICE AS DETERMINED BY A SELF - INVENTORY

Regional perinatal care is often criticized because local personnel are uninvolved in determining their “level” category. To intensify local input, we developed a self-assessment inventory of desired care practices and existing resources. The inventory includes a list of 48 high-risk conditions to be classified as requiring local care or referral and a list of 179 items for hospital equipment and staffing. 21 obstetricians (O), 16 pediatricians (P), 16 family physicians, and 84 perinatal nurses from 8 rural hospitals completed the inventories. The results of the inventory were compared with data obtained from 3-day site visits to the hospitals.O and P consistently felt that over 80% of Level II and III prenatal conditions should be managed locally, but they disagreed about referring neonatal conditions (O=46% refer; P=76% refer). 10.6% of the resources required for desired level of care were stated as not present in the hospitals. These results were 96% consistent with site visit observations. There were conflicting responses on 17.1% of the 179 items (i.e., some responders did not know many of their own resources).We conclude that 1) patient care goals frequently are not consistent with available resources and 2) the self inventory can replace site visits, identify discrepent patient care goals, accurately assess hospital facilities, and identify existing hospital resources not being utilized.