Obstetric Triage Scales; a Narrative Review

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Abstract

Introduction:

The growing demand for high-quality obstetric care and treatment has led to the advent and development of a field known as obstetric triage. The present review study aimed to examine the development of tools and criteria for obstetric triage services.

Methods:

In this narrative review, two authors searched for related articles using the keywords of “obstetric triage, gynecology triage, perinatal Triage, maternity triage, midwifery triage” AND “tool, index, scale, questionnaire, system”. With Persian and English language limitation, searches were performed in Scopus, Google Scholar, Scientific Information Database, ProQuest, Medline, Embase and Web of Science databases for articles published from 2000 to 2018.

Results:

Out of the 289 articles reviewed in this study, 8 articles met the eligibility criteria. Out of these 8 articles, 6 were dedicated to introducing a tool designed and only 2 introduced an obstetric triage system. The obstetric triage tools and systems covered included Emergency Severity Index (ESI), Obstetric Triage Acuity Scale (OTAS), Birmingham symptom specific obstetric triage system (BSOTS), Maternal Fetal Triage Index (MFTI), Florida Hospital Obstetric Triage Acuity Tool, self-assessment questionnaire for gynecologic emergencies (SAQ-GE) and Perinatal Emergency Team Response Assessment (PETRA). Overall, the validity and reliability of the studied method were investigated and found to be acceptable in only 5 of the reviewed studies.

Conclusion:

The review showed the lack of consensus on how to devise a single standardized tool or system for obstetric triage. The comparison of different obstetric triage tools and systems demonstrated the need for a standardized and widely-approved system with high validity and reliability and standard definitions for obstetric triage to determine the right priority and waiting times of obstetric care services.

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Most cited references 26

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Emergency Department Triage Scales and Their Components: A Systematic Review of the Scientific Evidence

Nasim Farrohknia, Maaret Castrén, Anna Ehrenberg … (2011)

Emergency department (ED) triage is used to identify patients' level of urgency and treat them based on their triage level. The global advancement of triage scales in the past two decades has generated considerable research on the validity and reliability of these scales. This systematic review aims to investigate the scientific evidence for published ED triage scales. The following questions are addressed: 1. Does assessment of individual vital signs or chief complaints affect mortality during the hospital stay or within 30 days after arrival at the ED? 2. What is the level of agreement between clinicians' triage decisions compared to each other or to a gold standard for each scale (reliability)? 3. How valid is each triage scale in predicting hospitalization and hospital mortality? A systematic search of the international literature published from 1966 through March 31, 2009 explored the British Nursing Index, Business Source Premier, CINAHL, Cochrane Library, EMBASE, and PubMed. Inclusion was limited to controlled studies of adult patients (≥15 years) visiting EDs for somatic reasons. Outcome variables were death in ED or hospital and need for hospitalization (validity). Methodological quality and clinical relevance of each study were rated as high, medium, or low. The results from the studies that met the inclusion criteria and quality standards were synthesized applying the internationally developed GRADE system. Each conclusion was then assessed as having strong, moderately strong, limited, or insufficient scientific evidence. If studies were not available, this was also noted. We found ED triage scales to be supported, at best, by limited and often insufficient evidence. The ability of the individual vital signs included in the different scales to predict outcome is seldom, if at all, studied in the ED setting. The scientific evidence to assess interrater agreement (reliability) was limited for one triage scale and insufficient or lacking for all other scales. Two of the scales yielded limited scientific evidence, and one scale yielded insufficient evidence, on which to assess the risk of early death or hospitalization in patients assigned to the two lowest triage levels on a 5-level scale (validity).

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Revisions to the Canadian Emergency Department Triage and Acuity Scale implementation guidelines.

, , Michael J Bullard … (2004)

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The third delay: understanding waiting time for obstetric referrals at a large regional hospital in Ghana

David M Goodman, Emmanuel K. Srofenyoh, Adeyemi J Olufolabi … (2017)

Background Delay in receiving care significantly contributes to maternal morbidity and mortality. Much has been studied about reducing delays prior to arrival to referral facilities, but the delays incurred upon arrival to the hospital have not been described in many low- and middle-income countries. Methods We report on the obstetric referral process at Ridge Regional Hospital, Accra, Ghana, the largest referral hospital in the Ghana Health System. This study uses data from a prospectively-collected cohort of 1082 women presenting with pregnancy complications over a 10-week period. To characterize which factors lead to delays in receiving care, we analyzed wait times based on reason for referral, time and day of arrival, and concurrent volume of patients in the triage area. Results The findings show that 108 facilities refer patients to Ridge Regional Hospital, and 52 facilities account for 90.5% of all transfers. The most common reason for referral was fetal-pelvic size disproportion (24.3%) followed by hypertensive disorders of pregnancy (9.8%) and prior uterine scar (9.1%). The median arrival-to-evaluation (wait) time was 40 min (IQR 15–100); 206 (22%) of women were evaluated within 10 min of arrival. Factors associated with longer wait times include presenting during the night shift, being in latent labour, and having a non-time-sensitive risk factor. The median time to be evaluated was 32 min (12–80) for women with hypertensive disorders of pregnancy and 37 min (10–66) for women with obstetric hemorrhage. In addition, the wait time for women in the second stage of labour was 30 min (12–79). Conclusions Reducing delay upon arrival is imperative to improve the care at high-volume comprehensive emergency obstetric centers. Although women with time-sensitive risk factors such as hypertension, bleeding, fever, and second stage of labour were seen more quickly than the baseline population, all groups failed to be evaluated within the international standard of 10 min. This study emphasizes the need to improve hospital systems so that space and personnel are available to access high-risk pregnancy transfers rapidly.

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Author and article information

Journal

Journal ID (nlm-ta): Arch Acad Emerg Med

Journal ID (iso-abbrev): Arch Acad Emerg Med

Journal ID (publisher-id): AAEM

Title: Archives of Academic Emergency Medicine

Publisher: Shahid Beheshti University of Medical Sciences (Tehran, Iran )

ISSN (Electronic): 2645-4904

Publication date Collection: Winter 2019

Publication date (Electronic): 13 January 2019

Volume: 7

Issue: 1

Electronic Location Identifier: e13

Affiliations

[1 ]Students Research Committee, Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Email: Rashidiff@yahoo.com, orcid.org/0000-0001-7498-475X

[2 ]Midwifery and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Email: msimbar@gmial.com , orcid.org/0000-0003-2843-3150

[3 ]Mahdiyeh Hospital Clinical Research Development Unit, Shahid Beheshti University of Medical Sciences and Health Service, Tehran Islamic Republic of Iran. Email: shahrzad.modarres2014@gmail.com , orcid.org/0000-0002-0584-4240.

[4 ]Department of Biostatics, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Email:alavimajd@gmail.com , orcid.org/0000-0001-7772-2923

Author notes

[* ]Corresponding Author: Masoumeh Simbar; Midwifery and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Phone numbers: +982133020695, Fax: +982133020695, Postal code: 00989115386991, E-mail address: msimbar@yahoo.com

Article

Publisher ID: aaem-7-e13

PMC ID: 6377224

PubMed ID: 30847448

SO-VID: 727a4e54-e724-4c60-81ec-58f6d014abdc

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License, ( http://creativecommons.org/licenses/by/3.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Obstetric Triage Scales; a Narrative Review

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Abstract

Introduction:

Methods:

Results:

Conclusion:

Related collections

Advocacy for Maternal and Women’s Health

Most cited references 26

Emergency Department Triage Scales and Their Components: A Systematic Review of the Scientific Evidence

Revisions to the Canadian Emergency Department Triage and Acuity Scale implementation guidelines.

The third delay: understanding waiting time for obstetric referrals at a large regional hospital in Ghana

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