Department of Obstetrics and Gynecology, MedStar Washington Hospital Center, Washington, DC (Drs Kodama, Mokhtari, Iqbal, and Kawakita).
Department of Obstetrics and Gynecology, MedStar Washington Hospital Center, Washington, DC (Drs Kodama, Mokhtari, Iqbal, and Kawakita); Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA (Dr Kawakita).
Am J Obstet Gynecol MFM. 2021 Jul;3(4):100351. doi: 10.1016/j.ajogmf.2021.100351. Epub 2021 Mar 20.
The Maternal-Fetal Triage Index is a 5-level system to facilitate the care of pregnant women seeking care in an obstetrical triage unit (priority 1 being the highest acuity and priority 5 being the lowest acuity). Although the American College of Obstetricians and Gynecologists recommends implementing labor and delivery triage tools, it remains unclear whether the Maternal-Fetal Triage Index facilitates the timely evaluation of high-acuity pregnant women.
We sought to examine the duration of a labor and delivery triage evaluation before and after the implementation of the Maternal-Fetal Triage Index. We also sought to examine the duration of a labor and delivery triage evaluation according to priority levels by the Maternal-Fetal Triage Index.
This was a retrospective quality improvement study of all women presenting to an urban, tertiary labor and delivery triage unit at 16 weeks' gestation or later from December 2017 to February 2018 (historical cohort) and December 2018 to February 2019 (study cohort). As part of a quality improvement initiative, the Maternal-Fetal Triage Index was implemented in the labor and delivery unit in May 2018. All registered nurses who worked in the labor and delivery unit completed a formal education course and assigned the priority levels at the time of triage presentation. The primary outcome was the duration of a labor and delivery triage evaluation, which was defined as the time interval from triage presentation to the completion of history and physical examination in the electronic medical record. Secondary outcomes included the rates of labor and delivery unit admissions.
There were 1305 and 1374 women in the historical cohort and study cohort, respectively. The duration of labor and delivery triage evaluation was longer for the study cohort than for the historical cohort (64 minutes vs 61 minutes; P=.02). Of the 1374 women in the study cohort, there were 28 (2%), 290 (21%), 459 (33%), 462 (34%), and 135 (10%) women with priority levels 1, 2, 3, 4, and 5 assigned, respectively. Women with a higher priority according to the Maternal-Fetal Triage Index had a shorter labor and delivery triage evaluation (priority 1, 57 minutes; priority 2, 66 minutes; priority 3, 63 minutes; priority 4, 62 minutes; and priority 5, 83 minutes; P<.001). The rates of admission were higher in the priority 1 and 5 groups (priority 1, 89.3%; priority 2, 41.4%; priority 3, 57.3%; priority 4, 53.3%; and priority 5, 92.6%; P<.001).
Compared with the historical cohort, the duration of labor and delivery triage evaluation was longer in the study cohort. However, in the study cohort, women classified as higher priority according to the Maternal-Fetal Triage Index had a shorter labor and delivery triage evaluation. Our study supports the American College of Obstetricians and Gynecologists' recommendation on the implementation and utilization of labor and delivery triage tools such as the Maternal-Fetal Triage Index.
胎儿产妇分诊指数是一个 5 级系统，用于为在产科分诊单位寻求护理的孕妇提供便利（优先级 1 是最高的 acuity，优先级 5 是最低的 acuity）。尽管美国妇产科医师学会建议实施分娩和分娩分诊工具，但仍不清楚胎儿产妇分诊指数是否有助于及时评估高 acuity 孕妇。
我们旨在检查在实施胎儿产妇分诊指数前后分娩和分娩分诊评估的持续时间。我们还旨在根据胎儿产妇分诊指数的优先级水平检查分娩和分娩分诊评估的持续时间。
这是一项对 2017 年 12 月至 2018 年 2 月（历史队列）和 2018 年 12 月至 2019 年 2 月（研究队列）在 16 周妊娠或以上到城市三级分娩分诊单位就诊的所有妇女进行的回顾性质量改进研究。作为质量改进计划的一部分，胎儿产妇分诊指数于 2018 年 5 月在分娩单位实施。在分娩单位工作的所有注册护士都完成了一次正式教育课程，并在分诊时分配了优先级。主要结果是分娩和分娩分诊评估的持续时间，定义为从分诊到电子病历中完成病史和体检的时间间隔。次要结果包括分娩单位入院率。
历史队列和研究队列中分别有 1305 名和 1374 名妇女。与历史队列相比，研究队列的分娩和分娩分诊评估持续时间更长（64 分钟对 61 分钟；P=.02）。在研究队列的 1374 名妇女中，分别有 28 名（2%）、290 名（21%）、459 名（33%）、462 名（34%）和 135 名（10%）妇女被分配了优先级 1、2、3、4 和 5。根据胎儿产妇分诊指数分配更高优先级的妇女分娩和分娩分诊评估时间更短（优先级 1，57 分钟；优先级 2，66 分钟；优先级 3，63 分钟；优先级 4，62 分钟；优先级 5，83 分钟；P<.001）。优先级 1 和 5 组的入院率更高（优先级 1，89.3%；优先级 2，41.4%；优先级 3，57.3%；优先级 4，53.3%；优先级 5，92.6%；P<.001）。
与历史队列相比，研究队列的分娩和分娩分诊评估持续时间更长。然而，在研究队列中，根据胎儿产妇分诊指数被归类为更高优先级的妇女分娩和分娩分诊评估时间更短。我们的研究支持美国妇产科医师学会关于实施和利用分娩和分娩分诊工具（如胎儿产妇分诊指数）的建议。
