Gratton Robert J, Bazaracai Neila, Cameron Ian, Watts Nancy, Brayman Colleen, Hancock Gregg, Twohey Rachel, AlShanteer Suhair, Ryder Jennifer E, Wodrich Kathryn, Williams Emily, Guay Amélie, Basso Melanie, Smithson David S
Department of Obstetrics & Gynaecology, Schulich School of Medicine & Dentistry, University of Western Ontario, London ON; London Health Sciences Centre, London ON.
Department of Obstetrics & Gynaecology, Schulich School of Medicine & Dentistry, University of Western Ontario, London ON.
J Obstet Gynaecol Can. 2016 Feb;38(2):125-33. doi: 10.1016/j.jogc.2015.12.010. Epub 2016 Feb 28.
A five-category Obstetrical Triage Acuity Scale (OTAS) was developed with a comprehensive set of obstetrical determinants. The purposes of this study were: (1) to compare the inter-rater reliability (IRR) in tertiary and community hospital settings and measure the intra-rater reliability (ITR) of OTAS; (2) to establish the validity of OTAS; and (3) to present the first revision of OTAS from the National Obstetrical Triage Working Group.
To assess IRR, obstetrical triage nurses were randomly selected from London Health Sciences Centre (LHSC) (n = 8), Stratford General Hospital (n = 11), and Chatham General Hospital (n= 7) to assign acuity levels to clinical scenarios based on actual patient visits. At LHSC, a group of nurses were retested at nine months to measure ITR. To assess validity, OTAS acuity level was correlated with measures of resource utilization.
OTAS has significant and comparable IRR in a tertiary care hospital and in two community hospitals. Repeat assessment in a cohort of nurses demonstrated significant ITR. Acuity level correlated significantly with performance of routine and second order laboratory investigations, point of care ultrasound, nursing work load, and health care provider attendance. A National Obstetrical Triage Working Group was formed and guided the first revision. Four acuity modifiers were added based on hemodynamics, respiratory distress, cervical dilatation, and fetal well-being.
OTAS is the first obstetrical triage scale with established reliability and validity. OTAS enables standardized assessments of acuity within and across institutions. Further, it facilitates assessment of patient care and flow based on acuity.
采用一套全面的产科决定因素制定了一个五类产科分诊 acuity 量表（OTAS）。本研究的目的是：（1）比较三级医院和社区医院环境中的评分者间信度（IRR）并测量 OTAS 的评分者内信度（ITR）；（2）确定 OTAS 的效度；（3）展示国家产科分诊工作组对 OTAS 的首次修订。
为评估 IRR，从伦敦卫生科学中心（LHSC）（n = 8）、斯特拉特福综合医院（n = 11）和查塔姆综合医院（n = 7）随机选取产科分诊护士，根据实际患者就诊情况为临床场景分配 acuity 级别。在 LHSC，一组护士在九个月后重新接受测试以测量 ITR。为评估效度，将 OTAS acuity 级别与资源利用指标进行关联。
OTAS 在三级护理医院和两家社区医院中具有显著且可比的 IRR。对一组护士的重复评估显示出显著的 ITR。acuity 级别与常规和二级实验室检查、即时超声检查、护理工作量以及医护人员出勤情况显著相关。成立了国家产科分诊工作组并指导首次修订。根据血流动力学、呼吸窘迫、宫颈扩张和胎儿健康状况添加了四个 acuity 修正因子。
OTAS 是首个具有既定信度和效度的产科分诊量表。OTAS 能够在机构内部和机构之间对 acuity 进行标准化评估。此外，它有助于根据 acuity 评估患者护理和流程。
