Implementation of a Contemporary Model for Obstetric Triage Using AWHONN’s Maternal Fetal Triage Index

Abstract

To implement a contemporary model for obstetric triage using the Maternal Fetal Triage Index (MFTI) at Adventist Healthcare, Shady Grove Medical Center. An essential piece to improving the concerning state of maternal mortality and morbidity in the United States lies in increasing the ability to deliver life-saving emergency interventions in a timely manner. Historically, pregnant women who present for care have been seen in the labor and delivery unit as opposed to the emergency department. Until the creation of the MFTI, there was no standardized tool for prioritization and assessment of these patients. Our goal was to improve quality of care by decreasing patient wait times and by identifying patients with emergencies or potentially emergent conditions as quickly as possible. An interdisciplinary team composed of nurses, providers, registrars, and unit support coordinators met monthly for 1 year before implementation. We developed a comprehensive educational plan for all obstetric nurses, incorporating the MFTI into the new workflow. A 2-week trial run was completed on both shifts to assess for barriers. Presentation to assessment time was kept for all patients who presented for care for 1 year before implementation and for 6 months after implementation. Detailed logs were maintained of assigned priority levels as well as the time until a priority one patient was in a 1:1 nursing care assignment. Mean wait time was significantly decreased by 5.7 min (p < .01). Since implementation, all patients identified as priority one–stat were in a direct 1:1 nursing care assignment within 10 min of presentation to the unit. Because there was no method to identify these patients before implementation, we were unable to compare timeliness of care. A standardized model for obstetric triage is crucial in providing superior perinatal care and is vital to the efficient flow of every labor and delivery unit. Our contemporary model uses the MFTI, and it significantly decreases patient wait times. In addition, it allows for the clear and rapid identification of potentially emergent patients so that care can be as timely as possible.