Implementing an Obstetric Triage Acuity Tool in a High-Volume Obstetric Unit

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INTRODUCTION: Our objective was to evaluate an obstetric triage acuity tool that we developed and implemented in January 2013. METHODS: A four-level triage acuity tool, Level 1 (most acute) to Level 4 (least acute), was developed to prioritize patients presenting for urgent care to the obstetric triage unit. Acuity scores, assigned by a triage nurse, dictated acceptable wait times for a medical screening examination (Level 1, 5 minutes; Level 2, 15 minutes; Level 3, 30 minutes; Level 4, 60 minutes). This was a prospective cohort study of all 2,228 urgent triage visits from March 1 to May 31, 2013. The validity of obstetric triage acuity tool was evaluated by comparing hospital admission rates across acuity levels to determine whether admission rates increased with increasing acuity level. Wait times from acuity score to medical screening examination and to final disposition were calculated and assessed by acuity level. RESULTS: Admission rates increased significantly across acuity levels from least acute to most acute; admission rates at Level 4, 3, 2, and 1 were respectively, 16%, 40%, 54%, and 84%, respectively (Table 1; P<.001). Goals for acceptable wait time for a medical screening examination were met for 89% of Level 1, 84% of Level 2, 91% of Level 3, and 94% of Level 4 visits.CONCLUSIONS: Increasing hospital admission rates across acuity levels supports the validity of obstetric triage acuity tool. Since implementing the obstetric triage acuity tool, most patients presenting for urgent care were seen for a medical screening examination within clinically acceptable wait times.