The Development and Implementation of an Obstetrical Triage Tool to Prioritize Patients and Track Process Times by Risk Categories.

Document Type

Article

Publication Date

6-2014

Institution/Department

Nursing

Journal Title

JOGNN: Journal of Obstetric, Gynecologic & Neonatal Nursing

MeSH Headings

Obstetric Emergencies; Triage; Human; Quality Improvement; United States; Multidisciplinary Care Team; Pregnancy; Female; Female

Abstract

Objective To develop an evidence-based tool with an electronic version for process time tracking for obstetric triage to standardize and prioritize care. Design Evidence-based, quality improvement project. Sample All women admitted for obstetric evaluation at a large medical center in northeastern United States between December 1, 2012 and August 31, 2013. Methods This quality improvement project started as an interdisciplinary collaboration to identify a problem with variability in the procedure and assignment of obstetric triage categories. A literature review showed that lack of a standardized tool to assess acuity, a clear definition of process time targets, and a method to provide feedback to clinicians were risks that compromised patient safety and quality of care. Implementation Strategies In November 2012, a paper version of a triage tool was developed based on modifications of acuity assessment instruments found in the literature. Color-coded triage categories (emergent = red, urgent = yellow, and nonurgent = green) were assigned from a brief standardized nursing assessment of presenting clinical symptoms. Nurses and physicians were educated about the triage tool, and triage guidelines were developed to support the interdisciplinary process. With assistance from the information technology department, an electronic version of the tool was created in Microsoft Excel to calculate triage process intervals and generate monthly tables and trend line graphs for performance metrics. Results Of the 2,588 women, 5% (n = 119) were categorized red, 77% (n = 2,004) were categorized yellow, and 18% (n = 465) were categorized green. A 5-minute target for arrival to triage times was met 86%, 73%, and 69% of the time for the red, yellow, and green categories, respectively (M = 3.6, 3.9, and 5.2 minutes). This represents a change from baseline of 75%, 78%, and 50%, respectively. Targets for time from provider notified to patient seen were 5, 30, and 60 minutes for the three categories, which were met 50%, 62%, and 73% of the time (M = 12.7, 18.2, and 21.7 minutes). The greatest admission times were between 1500 to 1900 hours (23%) and 1100 to 1500 hours (22%). Conclusion/Implications for Nursing Practice As a result, a triage nurse role was established within 2 months to facilitate timely screening to reduce process times and increase the number of patients meeting the performance targets. Staffing has been adjusted to cover the high admission times. Nurse-physician communication improved with the use of the standardized tool. Current activities are focused on developing policies, improving process targets through interdisciplinary teamwork, and integrating the triage categories in the electronic health record.

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S67

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