Mahatma Gandhi Institute of Medical Sciences, Sevagram, Maharashtra, India.
Obstetrics and Gynecology, Mahatma Gandhi Institute of Medical Sciences, Sevagram, India
BMJ Open Qual. 2024 May 7;13(Suppl 1):e001870. doi: 10.1136/bmjoq-2022-001870.
Triaging of obstetric patients by emergency care providers is paramount. It helps provide appropriate and timely management to prevent further injury and complications. Standardised trauma acuity scales have limited applicability in obstetric triage. Specific obstetric triage index tools improve maternal and neonatal outcomes but remain underused. The aim was to introduce a validity-tested obstetric triage tool to improve the percentage of correctly triaged patients (correctly colour-coded in accordance with triage index tool and attended to within the stipulated time interval mandated by the tool) from the baseline of 49% to more than 90% through a quality improvement (QI) process.A team of nurses, obstetricians and postgraduates did a root cause analysis to identify the possible reasons for incorrect triaging of obstetric patients using process flow mapping and fish bone analysis. Various change ideas were tested through sequential Plan-Do-Study-Act (PDSA) cycles to address issues identified.The interventions included introduction and application of an obstetric triage index tool, training of triage nurses and residents. We implemented these interventions in eight PDSA cycles and observed outcomes by using run charts. A set of process, output and outcome indicators were used to track if changes made were leading to improvement.Proportion of correctly triaged women increased from the baseline of 49% to more than 95% over a period of 8 months from February to September 2020, and the results have been sustained in the last PDSA cycle, and the triage system is still sustained with similar results. The median triage waiting time reduced from the baseline of 40 min to less than 10 min. There was reduction in complications attributable to improper triaging such as preterm delivery, prolonged intensive care unit stay and overall morbidity. It can be thus concluded that a QI approach improved obstetric triaging in a rural maternity hospital in India.
对产科患者进行紧急护理分诊至关重要。它有助于提供适当和及时的管理，以防止进一步的伤害和并发症。标准化创伤严重程度评分在产科分诊中的适用性有限。特定的产科分诊指数工具可改善母婴结局，但仍未得到充分利用。目的是引入经过验证的产科分诊工具，以通过质量改进（QI）过程将正确分诊的患者比例（根据分诊指数工具正确标记颜色并在工具规定的时间间隔内进行处理）从基线的 49%提高到 90%以上。
一组护士、产科医生和研究生通过流程流程图和鱼骨图分析，对产科患者分诊错误的可能原因进行了根本原因分析。通过连续的计划-执行-研究-行动（PDSA）循环测试了各种变更想法，以解决发现的问题。
干预措施包括引入和应用产科分诊指数工具、对分诊护士和住院医生进行培训。我们在八个 PDSA 循环中实施了这些干预措施，并通过运行图观察结果。使用了一套过程、输出和结果指标来跟踪所做的更改是否导致改进。
在 2020 年 2 月至 9 月的 8 个月期间，正确分诊的女性比例从基线的 49%提高到 95%以上，并且在最后一个 PDSA 循环中结果得以维持，分诊系统仍在维持，结果相似。分诊等待时间中位数从基线的 40 分钟减少到不到 10 分钟。由于分诊不当导致的并发症（如早产、延长重症监护病房停留时间和整体发病率）有所减少。因此，可以得出结论，质量改进方法改善了印度农村一家产科医院的产科分诊。
