Purpose for the program: Pregnant patients frequently call obstetrical triage to speak with nurses in order to obtain obstetrical advice in regards to their pregnancies and concerns regarding impending labor. Nurses were providing a variety of advice responses and many were not documenting their instructions during these phone calls using outdated algorithms and documentation forms. It not only created a liability for the hospital and the triage nurses, but also created a safety issue for the patients on the phone. It became clear that an evidence based process needed to be put in place to guide nurses’ telephone assessments for obstetrical patients.

Proposed change: A telephone triage process that provides nurses with algorithms and standard documentation to utilize during patient calls to obstetrical triage. This process will help to ensure that advice remains consistent among the nurses, and will correlate with system standardized discharge instructions.

Implementation, outcomes and evaluation: The current obstetrical telephone triage process was put into practice in June 2009. A standardized documentation form was developed for effective and efficient documentation of calls.  Standardized algorithms were made available to nurses to reference for phone assessment and to provide advice based on the type of patient complaint that was provided.  Since implementation, staff have demonstrated a significant increase in documentation compliance. Banner Thunderbird Medical Center obstetrical triage nurses who voluntarily took an anonymous survey reported they agreed that the ability of obstetrical triage nurses to provide safe patient care to telephone triage patients has been improved since the implementation of the obstetrical telephone triage process.

Implications for nursing practice: The Banner Thunderbird Medical Center obstetrical telephone triage process is supported by peer-reviewed literature, as well as statements by the American Congress of Obstetricians and Gynecologists and the Association of Women's Health, Obstetric and Neonatal Nurses.  Nursing compliance with documentation of obstetrical telephone triage phone calls has improved significantly since implementation of the process.  Nurses perceive a greater reduction of risk for the hospital and themselves; and agree that they are able to provide safer patient care as a result of the process implementation.

Keywords: Obstetrical telephone triage, reduced liability, patient safety, telephone assessment, telephone advice