A
The Development and Implementation of an Obstetrical Triage Tool to Prioritize Patients and Track Process Times By Risk Categories
Title: The Development and Implementation of an Obstetrical Triage Tool to Prioritize Patients and Track Process Times By Risk Categories
- Summarize the literature and the available evidence for the development of the obstetrical triage tool.
- Discuss the education process of implementing the obstetrical triage tool for nurses and physicians and development of the nursing guidelines.
- Describe the development of the electronic version of the obstetrical triage tool for analyzing and summarizing obstetrical triage metrics and how the results are used for safety monitoring and quality improvement.
Design: Evidence-based, quality improvement project.
Sample: All patients admitted for obstetrical evaluation at a large northeastern U.S. medical center between December 1, 2012 and August 31, 2013.
Methods: This quality improvement project started as an interdisciplinary collaboration which initially identified a problem with variability in the procedure and assignment of obstetric triage categories. A literature review showed that the 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 non-urgent=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 using an Excel software package was created which calculates triage process intervals, generates monthly tables and trend line graphs for performance metric
Results: Of the 2588 patients, 5% (n=119) were categorized red, 77% (n=2004) yellow, and 18% (n=465) 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 (M = 3.6, 3.9, and 5.2 minutes). This represents a change from baseline of 75%, 78% and 50% respectively. Targets for ‘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 highest ‘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 two months to facilitate timely screening to reduce process times, 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.
Keywords: Obstetrical, Triage, Tool