London Health Sciences Centre, Western University, Department of Obstetrics and Gynaecology, London, Ontario, Canada.
Am J Obstet Gynecol. 2013 Oct;209(4):287-93. doi: 10.1016/j.ajog.2013.03.031. Epub 2013 Mar 25.
A 5-category Obstetric Triage Acuity Scale (OTAS) was developed with a comprehensive set of obstetrical determinants. The objectives of this study were as follows: (1) to test the interrater reliability of OTAS and (2) to determine the distribution of patient acuity and flow by OTAS level. To test the interrater reliability, 110 triage charts were used to generate vignettes and the consistency of the OTAS level assigned by 8 triage nurses was measured. OTAS performed with substantial (Kappa, 0.61 - 0.77, OTAS 1-4) and near perfect correlation (0.87, OTAS 5). To assess patient flow, the times to primary and secondary health care provider assessments and lengths of stay stratified by acuity were abstracted from the patient management system. Two-thirds of triage visits were low acuity (OTAS 4, 5). There was a decrease in length of stay (median [interquartile range], minutes) as acuity decreased from OTAS 1 (120.0 [156.0] minutes) to OTAS 3 (75.0 [120.8]). The major contributor to length of stay was time to secondary health care provider assessment and this did not change with acuity. The percentage of patients admitted to the antenatal or birthing unit decreased from 80% (OTAS 1) to 12% (OTAS 5). OTAS provides a reliable assessment of acuity and its implementation has allowed for triaging of obstetric patients based on acuity, and a more in-depth assessment of the patient flow. By standardizing assessment, OTAS allows for opportunities to improve performance and make comparisons of patient care and flow across organizations.
一个 5 级产科分诊 acuity 量表（OTAS）是用一套全面的产科决定因素开发的。本研究的目的如下：（1）检验 OTAS 的组内一致性；（2）通过 OTAS 水平确定患者 acuity 和流程的分布。为了检验组内一致性，使用 110 份分诊图表生成 vignettes，并测量 8 名分诊护士分配的 OTAS 水平的一致性。OTAS 表现出显著的（Kappa，0.61-0.77，OTAS 1-4）和近乎完美的相关性（0.87，OTAS 5）。为了评估患者流程，从患者管理系统中提取了按 acuity 分层的初级和二级医疗保健提供者评估时间和停留时间。三分之二的分诊就诊为低 acuity（OTAS 4、5）。随着 acuity 从 OTAS 1（120.0 [156.0] 分钟）下降到 OTAS 3（75.0 [120.8] 分钟），停留时间（中位数[四分位数范围]，分钟）缩短。停留时间的主要贡献者是二级医疗保健提供者评估时间，这与 acuity 无关。入院到产前或分娩单位的患者比例从 80%（OTAS 1）下降到 12%（OTAS 5）。OTAS 对 acuity 进行了可靠的评估，其实施允许根据 acuity 对产科患者进行分诊，并对患者流程进行更深入的评估。通过标准化评估，OTAS 为提高绩效提供了机会，并为跨组织的患者护理和流程比较提供了机会。
