Triage of obstetric presentations to the ED. Who are they and how are they triaged? Analysis of an obstetric triage decision aid.

Ms Mary McCarthy1, Dr Wendy Pollock1,2,3, Professor Susan  McDonald1,2
1Mercy Hosptial For Women, Heidelberg, Australia, 2La Trobe University, Bundoora, Australia, 3Melbourne University, Parkville, Australia

Background: Emergency nurses are typically not well-versed in the triage of pregnant and postpartum women. The obstetric triage decision aid (OTDA) was developed to provide structured and standardised triage of pregnant and postpartum women with obstetric and non-obstetric complaints. The validated OTDA consists of 10 common pregnancy complaints with key signs and symptoms, generating an Australasian Triage Scale category based on the targeted questioning responses. The aim of this analysis was to examine the characteristics of obstetric presentation and explore how they were triaged using the OTDA.
Method: In February 2017, the OTDA was introduced to the ED of a metropolitan hospital in Melbourne. New procedures on obstetric triage and support processes were provided to underpin the introduction, and the OTDA was embedded into the ED triage software. Data were extracted for September2017 and underwent non-parametric analysis using SPSS v24. Ethics approval was obtained.
Results: Of the 228 obstetric presentations, ED nurses conducted triage without using the OTDA for 68 (29.8%) women. The majority of presentations were for bleeding and pain in the first trimester (n=29; 43%), of these 21 (72%) were given the equivalent triage score to the OTDA, two (7%) were under triaged and six (21%) had insufficient details to provide a score using the OTDA. Of the presentations for problems over 20 weeks’ gestation (n=24; 35%) only 42% (n= 10) received the same triage score. Seven (29%) were under triaged and 25% (n=6) had insufficient details to give a score in the OTDA. Whilst only six (9%) presentations were in the postnatal period, four (67%) were under triaged and two (33%) received the same score as the OTDA.
Conclusion: The most common pregnancy related problem was early pregnancy bleeding and pain and had the highest concordance with the OTDA score, however under-triage with women over 20 weeks and postnatal problems remained a concern. Under-triage is a known clinical risk and  the OTDA was useful in assisting in the application of a triage score in the ED.

Project lead for the BCV Obstetric triage decision Aid. Is a Registered Nurse/ Midwife, Bachelor of Health Science Nursing, Masters Midwifery. As Manager of the Mercy Women’s Emergency Department has worked extensively to improve the consistency of obstetric triage, customised the Australasian Triage Scale to emergency maternity care and published :“Triage of pregnant women in the emergency department: evaluation of a triage decision aid. EMJ”. Further refinement has produced an Obstetric Triage Decision Aid which has been successfully implemented in both the general emergency setting and maternity unit. In addition has an interest on improving communication in the ED for women who experience early pregnancy loss and developed an evidence base education package for staff who work in the ED.