Exclusion Criteria for an Obstetrics-Specific Ambulance Bay

Abstract

In preparation for the move of an obstetric service to a newly constructed tower physically separated from the emergency department, a multidisciplinary team created criteria for Emergency Medical Services’ (EMS) use of an obstetric-specific ambulance bay. This project demonstrates a strong collaboration among a multidisciplinary group of health care teams and providers, including, but not limited to, nursing and physician leaders from the emergency department, obstetrics, NICU, and EMS. In addition, the project demonstrates development of care delivery systems with a focus on patient-centered care. During planning, not only was safety in mind but the patient experience remained at the forefront of discussions. A multidisciplinary patient access team started meeting more than 1 year before to the move and worked on several process changes, including a new workflow for obstetric patients arriving by EMS. With a goal of bringing obstetric patients directly to the most appropriate treatment team, an obstetric-specific ambulance bay was built in the new tower. Standard work was designed and exclusion criteria developed to create a process in which the emergency department command center nurses, obstetric triage nurses, and EMS personnel collaborate to determine the destination of incoming obstetric patients. In preparation for the new workflow, nursing staff reviewed the exclusion criteria and provided feedback. In response, a charge-nurse paging group was set up for improved communication. After the move, the exclusion list became practice and continues to be refined through quality improvement review. The implementation of an obstetric-specific ambulance bay coupled with patient education about the triage area in the new tower resulted in an increase in patient visits to obstetric triage of more than 11% in the first 9 months postmove. Postdischarge, patients have reported greater satisfaction with triage, which is reflected in our patient engagement scores, currently in the 84th percentile (up from 75th). Obstetric and emergency department nurses feel empowered to provide patients with access to the most appropriate care in a timely manner as well as patient-centered experiences. The multidisciplinary team remains engaged in reviewing safety concerns as well as in collaborating on any changes in exclusion criteria.