1102 Analysis of antepartum obstetric triage utilization at 24 weeks and beyond

Abstract

Antepartum obstetric triage visits represent a significant consumption of healthcare resources in pregnancy. We sought to understand the nature of antepartum obstetric triage utilization at 24 weeks and beyond which did not result in admission for delivery. This was a retrospective cohort of all women who delivered at or greater than 24 weeks within a single tertiary system between January 2014 and April 2017. We collected baseline characteristics, antepartum course and delivery outcomes. Information regarding all triage visits at 24 weeks and beyond, which did not result in an admission for delivery (either spontaneous or medically indicated), was included. To identify characteristics associated with higher triage utilization, we employed a Poisson intensity model, which assumes the number of recurrent events (triage visits) in non-overlapping time intervals follows a Poisson process. In this way, the intrinsic correlation between events occurred (triage visits) in the same pregnancy are taken into consideration. There were 10,611 pregnancies included in the study for a total of 17,992 triage visits which did not result in admission for delivery. The mean number of triage visits was 1.7 (sd=1.44, range 0-20) per patient, with 9278 (87.4%) pregnancies having at least 1 antepartum triage visit which did not result in delivery. (Figure 1) The most common reason for triage visits was labor evaluation, representing 32.2% (5800) of all triage visits. In the recurrent event model, age, race, marital status, insurance type, parity, history of preterm delivery, and infection in pregnancy, were associated with increased triage utilization. (Table 1) There are a large number of antepartum triage visits at or beyond 24 weeks not resulting in delivery, with a majority of patients using triage at least once prior to presentation for delivery, with the most common reason being labor evaluation. Understanding characteristics associated with increased antepartum triage utilization provides an opportunity to allocate healthcare resources most appropriately in pregnancy.View Large Image Figure ViewerDownload Hi-res image Download (PPT)