Abstract
Triage tools have been shown to increase efficiency and accuracy of obstetric triage, but no published tools exist for low income settings. A novel guideline was developed and implemented in the tertiary maternity hospital of Sierra Leone. A triage system was implemented using a quality improvement approach. A novel triage guide, mentorship, improved patient flow and training were introduced. Prospective data was collected at three points over 5 months, capturing allocated triage category accuracy according to the system. The number of patients correctly triaged was 43.22% (n=51) before implementation, 81.82% (n=117) two weeks after training and 87.85% (n=159) two months after training. There was strong evidence (p=0.002) for the 44.63% (95% CI 34.50% - 54.89%) increase in correct triage. Implementation of an obstetric triage system increased the amount of correctly triaged patients. Further research to evaluate patient outcomes, wait times and robust validation of this triage tool is needed. Key words: maternity, obstetric, emergency, triage, system, tool, guide, low income, low resource, developing country  
Highlights
Emergency medicine triage guides have been shown to improve quality and efficiency of care in emergency departments, providing a standardised structure (Rosedale et al, 2011)
The Obstetrical Triage Acuity Scale (OTAS) system in Canada is one of the first published and validated obstetric triage tools, with implementation leading to reduced use of resources and waiting times with an increase in staff satisfaction (Smithson et al, 2013)
A total of 442 patients were audited, 10% before implementation (n=118), 14% two weeks after (n=143) and 13% two months after (n=181) of total cases admitted to Outpatient Department (OPD) in the corresponding month
Summary
Emergency medicine triage guides have been shown to improve quality and efficiency of care in emergency departments, providing a standardised structure (Rosedale et al, 2011). Obstetric departments in high income settings have been slower to adopt a formal structure, despite this being identified as an area for improvement (Macones et al, 2016; Angelini and Howard, 2014). There are no published and validated triage tools suitable for a low resource setting, despite quality of care on arrival in referral centres being documented as an area in need of improvement (Forshaw et al, 2016). The authors highlighted the impact of the limitations of resources and environment on the implementation of any triage system This demonstrates both the potential use of a triage tool specific for a low-income setting, and the importance of ensuring that any system implemented is designed to be effective with the available resources. Improvement of patient flow and ensuring optimum use of resources is more vital than ever
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