Triage is derived from the French word trier “to sort”.  It is a common military hospital term that originated in the battle fields to sort the injured soldiers (Mahlmeister15, Austin7).   Triage is a systematic approach to rapid patient assessment that assigns priority to the patient based on the degree of need (Austin7).  The Emergency Department and the Obstetric Department in the hospital settings triage patients.  Because patients present to these departments with a wide range of critical and non-critical conditions, this triage process needs to be both timely and appropriate (Zimmerman25).  In these settings the purpose of triage is to classify patients based on the urgent nature of their condition to improve timeliness and cost-effectiveness of care by appropriately allocating resources therefore improving patient outcome (Angelini2, Austin7, and Mahlmeister15).
          In reviewing the literature (Beveridge8, Mackway-Jones14; Mahlmeister15; Zimmerman25; Fernandes, Tanabe, Giboy, et. al10; Gurney12) much has been written about the triage process, and a range of tools have been developed to appropriately triage patients in the Emergency Department.  These tools are used to place patients into categories based on the criticality of their condition. Each category has a time frame within which the patient’s further assessment and initial treatment should occur. In the obstetric area, however, there are no acuity tools developed since 1993, and no acuity tools that identify time frames for patient complaints.
          In a four-campus hospital system, the obstetric staff, risk management, and administration determined that creating an obstetric triage acuity assessment tool would improve the timeliness and appropriateness of how patients are sorted.  The system had been using a tool published in Canada in 1993 (MacDonald13). A survey was conducted to asses how and when obstetric triage nurses made their initial patient assessment, and how effective it was in appropriately sorting patients.  There was a wide range of responses indicating that some nurses used the tool when they first spoke to the patients, and others did not use it until after a further physical examination had been performed.   Upon discussion with the nurses, the majority indicated that there many patient conditions, which the tool did not identify and classify.
          Therefore a task force was created consisting of obstetric triage staff nurses, educators, a clinical specialist, risk managers and members of obstetric nursing leadership to develop an evidence based obstetric triage acuity assessment tool, and to review the entire obstetric triage process. After a review of literature and assessment of Emergency Department acuity tools and information on the obstetric triage process a new Triage Acuity Tool was developed.  This was presented to an interdisciplinary committee which included physicians as well as those listed above. The tool was further edited and was approved. In addition, a patient flow process algorithm was developed to be used in conjunction with the acuity tool to clarify the medical screening examination, outpatient reassessment, and admission processes.  These tools were trialed and were found to be effective in identifying triage acuity level.  Additionally patient reassessment parameters were clarified.