University of Liberia, College of Health Sciences, Monrovia, Liberia.
University of Liberia, College of Health Sciences, Monrovia, Liberia.
Midwifery. 2024 Aug;135:104024. doi: 10.1016/j.midw.2024.104024. Epub 2024 May 8.
Research in low- and middle-income countries has shown that maternal mortality is directly related to inadequate or absent obstetric (OB) triage systems. Standard triage systems and knowledge on triaging for obstetric emergencies are often absent or lacking in most healthcare systems in Liberia.
The objective of this research was to address the third delay defined as receiving adequate, quality care when a facility is reached by increasing knowledge through the establishment of a midwife-led, hospital-based OB triage system to stratify care based on risk and imminence of birth and to improve timely assessment at two district referral hospitals.
A quasi-experimental study design using a pre/post survey was employed for a midwife-led OB triage training course. Using a train-the-trainer model, five midwives were trained as champions, who in turn trained an additional 62 providers. Test results were analyzed with the R statistical software using paired sample t-test and descriptive statistics.
Pretest results revealed a knowledge and practice gap among OB providers on key components of the standard triage package. However, post-test mean scores were significantly higher (M = 79.6, SD = 2.32) than pre-test mean scores (M = 59.0, SD = 2.30) for participants following a 2-day training (p = <0.001).
Following a structured OB triage training, participants showed significant improvement in post-test OB triage scores.
Standard OB triage protocols incorporated into the policies and procedures of obstetric wards have the potential to improve knowledge and practice, addressing the third delay and reducing preventable, obstetrics-related deaths.
在中低收入国家开展的研究表明，孕产妇死亡率与产科（OB）分诊系统不完善或缺失直接相关。在利比里亚，大多数医疗保健系统通常缺乏标准的分诊系统和产科急症分诊知识。
本研究的目的是通过建立以助产士为主导的基于医院的 OB 分诊系统来解决第三个延迟问题，该系统根据风险和分娩的紧迫性对护理进行分层，并改善在两家地区转诊医院的及时评估，从而增加知识以解决定义为在到达医疗机构时获得足够优质护理的第三个延迟问题。
采用准实验研究设计，使用预/后调查进行助产士主导的 OB 分诊培训课程。使用培训师培训模式，培训了 5 名助产士作为拥护者，他们又培训了另外 62 名提供者。使用 R 统计软件分析测试结果，使用配对样本 t 检验和描述性统计。
预测试结果显示 OB 提供者在标准分诊包的关键组件方面存在知识和实践差距。然而，参与者在经过 2 天培训后，后测试的平均分数（M = 79.6，SD = 2.32）明显高于前测试的平均分数（M = 59.0，SD = 2.30）（p <0.001）。
在进行了结构化的 OB 分诊培训后，参与者在 OB 分诊测试中的后测试分数显示出显著提高。
将标准的 OB 分诊方案纳入产科病房的政策和程序中，有可能提高知识和实践水平，解决第三个延迟问题，减少可预防的产科相关死亡。
