Impact of Implementation of the Maternal-Fetal Triage Index on Patients Presenting With Severe Hypertension

Abstract

ABSTRACT The timely triage of pregnant patients presenting for emergent care is an important factor for decreasing maternal morbidity and mortality. The Maternal-Fetal Triage Index (MFTI) is an assessment tool developed by the Association of Women's Health, Obstetric and Neonatal Nurses in 2014 and endorsed by the American College of Obstetricians and Gynecologists (ACOG) in 2016 for triaging obstetrical patients presenting for emergent care. The Joint Commission has identified response time to severe hypertension, or preeclampsia, as one of its elements of performance. The aim of this study was to examine the management of women with severe hypertension before and after the implementation of MFTI. This was a prospective, observational study at a county-supported, urban academic hospital, serving medically indigent women. Included were women at ≥24 weeks of gestation, who presented in the hospital's obstetric triage unit with severe preeclampsia diagnosed by severe hypertension. Severe hypertension was defined as blood pressure (BP) ≥160/110 mm Hg. Excluded were those who were not admitted for delivery at the time of presentation. Patients with BP ≥160/110 mm Hg were given magnesium sulfate (MgSO4) prophylaxis and treated with intravenous hydralazine, labetalol, or immediate-release nifedipine. Patients admitted before the implementation of MFTI (between January 1, 2019, and December 31, 2019) represented epoch 1 of the cohort. Those admitted after MFTI implementation (between March 1, 2021, and September 30, 2021) made up epoch 2. Nursing staff used the criteria outlined in the MFTI to prioritize patient acuity. A 1 score is the highest priority, and a 5 score is the lowest priority. The primary outcome was the time interval to evaluate and manage women with severe hypertension before and after MFTI implementation, as measured by arrival time to provider assessment, arrival time to MgSO4 prophylaxis, and arrival time to the administration of antihypertensive medications. There were 370 patients in epoch 1, before MFTI implementation, and 254 patients in epoch 2, after implementation. The time from arrival to provider assessment improved significantly from epoch 1 to epoch 2 (median time: 44 minutes [interquartile range, 0–65 minutes] vs 17 minutes [IQR, 0–39 minutes], respectively; P < 0.001). The time from arrival to MgSO4 prophylaxis also improved (160 minutes [IQR, 109–256 minutes] vs 126 minutes [IQR, 85–258 minutes], respectively; P = 0.001). There was a decrease in the time from arrival to administration of antihypertensive medications between the 2 time frames (101 minutes [IQR, 61–177 minutes] in epoch 1 vs 66 minutes [IQR, 35–203 minutes] in epoch 2; P < 0.001). In a separate analysis, race and ethnicity did not factor into the performance of MFTI. Overall, there was an improvement in the evaluation and management of pregnant women with severe hypertension after the implementation of MFTI, regardless of race and ethnicity. Timely identification and management of this high-risk population may improve maternal morbidity and mortality.