Abstract
Background
The obstetric triage decision aid (OTDA) consists of 10 common pregnancy complaints
with key signs and symptoms generating a triage score based on targeted questioning
responses. It was developed to provide a standardised approach for obstetric triage
conducted by midwives and emergency nurses as neither professional group are expert
in the triage of pregnant and postpartum women.
Aim
To evaluate implementation of the OTDA into an emergency department (ED) and maternity
assessment unit (MAU).
Methods
The OTDA was introduced to the ED and MAU of a hospital in Australia. A range of implementation
strategies were utilised and assessed by pre and post staff survey, and a three-month
post-audit of unscheduled maternity presentations. The primary outcome was adoption
rate of the OTDA. Secondary outcomes were staff confidence and waiting times. Analyses
were undertaken using SPSS (v24). Paired analysis was conducted on staff surveys.
Results
There were a total of 2829 unscheduled presentations: ED (n = 708) and MAU (n = 2121), 88.1% were triaged using the OTDA, used more in the MAU than the ED (93.2%
vs 72.7%; p < .001). In the MAU, women seen within 15 min of arrival improved significantly from 42.0% to 78.0%. There was improvement in
the self-rated confidence (p = .002) and competence (p = .004) by nurses and midwives to conduct obstetric triage.
Conclusion
The introduction of the OTDA required different approaches to change practice. There
were improvements in staff self-rated confidence and competence, a reduction in clinical
risk associated with under-triage in the ED and improved prioritisation of care in
the MAU.
Keywords
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Article info
Publication history
Published online: June 25, 2021
Accepted:
June 7,
2021
Received in revised form:
June 3,
2021
Received:
January 15,
2021
Identification
Copyright
© 2021 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.
