Abstract
BackgroundFailure to identify severely ill obstetric patients seeking acute care, and hence delaying treatment, can lead to maternal morbidity and mortality. Triage is the prioritization of patients seeking emergency care, based on clinical decision-making tools assessing medical urgency. While triage has been applied in general emergency medicine for 30 years, there are only a few obstetric triage systems (OTS) and obstetric triage has hitherto been unknown in Sweden. Obstetric triage is more complex than general triage since both mother and fetus require assessment, and pregnancy-related physiological changes must be taken into account. This paper aims to describe the development and an initial evaluation of the first OTS in Sweden.MethodsA multidisciplinary team surveyed reasons to seek acute obstetric care and the current patient flow at the largest obstetric unit in Scandinavia, Sahlgrenska University Hospital, Gothenburg, Sweden, with about 10,000 deliveries/year. A semi-structured literature review on obstetric triage was undertaken. Based on the survey and the literature review the first Swedish OTS was developed and implemented. Patient satisfaction was followed by electronical questionnaires. Initial validity evaluation was performed, defined by the system’s ability to identify patients with need for hospital admission, stratified by acuity level.ResultsThe Gothenburg Obstetrical Triage System (GOTS) addresses the patient to one of five acuity levels based on both vital signs and 14 chief complaint algorithms. It entails recommendations for initial procedures of care as well as an acuity form for documentation. Initial evaluation of the system indicates good correlation between need for admission and acuity level. The implementation has provided the staff with an improved medical overview of the patients and patient flow and enabled the unit to monitor emergency care in a structured way. Implementation came along with increased patient and staff satisfaction.ConclusionThe GOTS is the first OTS developed in and for Sweden and implementation has improved management of obstetric patients seeking acute care. Patients are now prioritized according to level of acuity and the time to assessment and treatment of severely ill patients can be structurally evaluated. Both patients and staff express improved satisfaction with obstetric triage.
Highlights
Failure to identify severely ill obstetric patients seeking acute care, and delaying treatment, can lead to maternal morbidity and mortality
Phases 1 and 2 The predominant causes for contacting the coordinator or attending the unit were reduced fetal movements, vaginal bleeding, abdominal pain, signs of hypertensive disorder including preeclampsia, signs of prenatal or postpartum infection, premature contractions, contractions at term, suspected rupture of membranes and signs of mastitis. These conditions, together with severe conditions such as trauma towards the pregnant abdomen,headache/neurological symptoms, postpartum hemorrhage, chest pain, dyspnea and signs of venous thromboembolism constituted the foundation for the chief complaint algorithms
We present the first Swedish obstetric triage system, the Gothenburg Obstetric Triage System (GOTS), its development, implementation and initial evaluation
Summary
Failure to identify severely ill obstetric patients seeking acute care, and delaying treatment, can lead to maternal morbidity and mortality. Triage is the prioritization of patients seeking emergency care, based on clinical decision-making tools assessing medical urgency. For non-obstetric patients seeking acute care at an emergency department (ED), triage is performed at first contact with medical staff in order to determine acuity level and prioritize in accordance with clinical urgency. Triage systems applied in general ED include very few obstetric determinants and are not adapted to the physiological changes and disease spectrum specific to pregnancy and the postpartum period.
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