The Triage and Care of Pregnant Patients Outside of Labor & Delivery

Purpose for the program: A need to standardize the triage and care of pregnant patients presenting to the emergency department was identified, in part, due to an adverse patient outcome. Three slightly-differing policies were found to be in existence relating to the topic and a group of nurses, physicians, performance improvement coordinators, and educators met to review, update, and standardize the approach to care of these patients.  Subsequent meetings resulted in the creation of a triage algorithm and an outlined process for communication between departments and specialty areas.

Proposed change: A triage algorithm was designed to serve as a process map for standardized care of pregnant patients, that outlined the disposition of these patients based on their gestational age and presence of medical complaints.  Education was conducted on both the Labor & Delivery unit and in the Emergency Department on this process, as well as on a standard operating procedure drafted to improve communication between specialties, resulting in clearer disposition of these patients.

Implementation, outcomes and evaluation: A multidisciplinary group was convened to examine the issues, propose improvements for communication, and promote accountability.  During this journey, the opportunity presented itself to enable the development of a remote electronic fetal monitoring system that would address staffing issues and patient satisfaction by maximizing resources on the Labor & Delivery unit.  The process, begun about 1 1/2 years ago, is in its implementation phase.  The outcomes realized thus far include increased patient satisfaction with being able to stay in assigned rooms for monitoring.  The use of assigned portable telephones and fax transmittals has improved communication about expected arrivals/transfers.  Additionally, coordination of care has been improved between physicians in the Emergency Medicine and OB/GYN specialities.

Implications for nursing practice: Clarification of patient care criteria has reduced the role confusion on the parts of both ED and L&D nurses.  Care of this subset of patients has been streamlined and better defined.  The remote electronic fetal monitoring system has been very successful, and the nurses express their satisfaction with their ability to monitor patients while still being available to their colleagues on L&D.  In an effort to further improve collegiality, we expect to conduct further education to promote situational awareness of the nurses working in each respective specialty area.

Keywords: ED triage, pregnant patients, remote electronic fetal monitoring