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This was an innovation project supported by the Better Care Victoria Innovation Fund.
Lead organisation
Mercy Health
Partner
La Trobe University
Summary
Poor recognition of the severity of a pregnant woman’s illness poses a clinical risk, with under-triage delaying assessment and treatment. Delayed care can have a negative impact on a pregnant woman and her baby’s health outcomes, yet there is no national obstetric or pregnancy decision support tool to assist in triaging this group of patients.
Maternity assessment units (MAUs) do not typically have a triage process for women who present unexpectedly with a pregnancy issue and women are typically seen in order of their arrival rather than their clinical urgency. And while it is routine for emergency departments (EDs) to triage patients, the generalised nature of their process may not always be optimal for determining the urgency of this cohort’s need for treatment.
To support the consistent, accurate and timely assessment of pregnant and postpartum women, Mercy Health developed and implemented an obstetric triage decision aid (OTDA) at the Werribee Mercy Hospital ED and MAU.
Aims
- Establish the use of the OTDA as the regular and routine process to conduct obstetric triage in both the ED and MAU
- Reduce variation in clinical practice by standardising the triage of pregnant and postpartum women with obstetric and non-obstetric clinical complaints
- Reduce the clinical risk of under-triage which may lead to a delay in treatment
- Promote timely access to care that is appropriate and consistent with the identified level of clinical urgency
- Strengthen safe and high-quality clinical practice, and potentially reduce negative outcomes for pregnant and postpartum women and their unborn babies
Outcomes
- Developed an OTDA that was used to assess 88 per cent of women presenting to the ED or MAU with pregnancy or postpartum concerns
- Demonstrated that the OTDA appropriately prioritises care, with higher triage categories shown to be associated with increased likelihood of hospital admission
- Reduced the waiting time from arrival to triage for women presenting to the MAU
- Reduced the waiting time from triage to cardiotocography for women presenting with concerns about their baby’s wellbeing
- Improved nurses and midwives’ confidence and competence in conducting an obstetric triage
Update
December 2020 – Work is continuing to develop the obstetric triage decision aid software application.