Abstract
BackgroundNo standardised system of triage exists in Maternity Care and local audit identified this to be problematic. We designed, implemented and evaluated an Obstetric Triage System in a large UK maternity unit. This includes a standard clinical triage assessment by a midwife, within 15 min of attendance, leading to assignment to a category of clinical urgency (on a 4-category scale). This guides timing of subsequent standardised immediate care for the eight most common reasons for attendance. A training programme was integral to the introduction.MethodsA mixed methods evaluation was conducted. A structured audit of 994 sets of maternity notes before and after implementation identified the number of women seen within 15 min of attendance. Secondary measures reviewed included time to subsequent care and attendance. An inter-operator reliability study using scenarios was completed by midwives. A focus group and two questionnaire studies were undertaken to explore midwives’ views of the system and to evaluate the training. In addition a national postal survey of practice in UK maternity units was undertaken in 2015.ResultsThe structured audit of 974/992 (98%) of notes demonstrated an increase in the number of women seen within 15 min of attendance from 39% before implementation to 54% afterwards (RR (95% CI) 1.4 (1.2, 1.7) p = <0.0001).Excellent inter-operator reliability (ICC 0.961 (95% CI 0.91–0.99)) was demonstrated with breakdown showing consistently good rates.Thematic analysis of focus group data (n = 12) informed the development of the questionnaire which was sent to all appropriate midwives. The response rate was 53/79 (67%) and the midwives reported that the new system helped them manage the department and improved safety.The National Survey (response rate 85/135 [63%]) demonstrated wide variation in where women are seen and staffing models in place. The majority of units 69/85 (81%) did not use a triage system based on clinical assessment to prioritise care.ConclusionsThis obstetric triage system has excellent inter- operator reliability and appears to be a reliable way of assessing the clinical priority of women as well as improving organisation of the department. Our survey has demonstrated the widespread need for implementation of such a system.
Highlights
No standardised system of triage exists in Maternity Care and local audit identified this to be problematic
Triage systems ensure that patients receive the level of care appropriate to their clinical priority, and that resources are used effectively
Such systems are common in Emergency Medicine Departments with many based on the Manchester Triage System (MTS), launched in the United Kingdom (UK) in 1997 [1]
Summary
No standardised system of triage exists in Maternity Care and local audit identified this to be problematic. We designed, implemented and evaluated an Obstetric Triage System in a large UK maternity unit This includes a standard clinical triage assessment by a midwife, within 15 min of attendance, leading to assignment to a category of clinical urgency (on a 4-category scale). The physiological changes associated with pregnancy mean the general parameters of standard triage tools may not be applicable, as pregnancy is associated with an increased resting heart rate, lower blood pressure and increased respiratory rate in the mother. This together with the underlying good health of the maternity population may mask the severity of maternal illness unless a specific assessment is undertaken by appropriately trained health care professionals. There is no means of assessing the condition of the unborn baby in existing triage tools
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