The handbook, Obstetric Triage and Emergency Care Protocols is a recent publication focusing exclusively on topics encountered in obstetric triage and developed as narrative protocols with decision algorithms by both timing in pregnancy and clinical topic. One example, in a large tertiary care setting, the provider team consisted of one midwife and one third or fourth year resident, with the addition of an emergency medicine resident, and a student physician assistant. Labor triage requires a comprehensive understanding of the labor process, an evaluation of the maternal and fetal response to labor, and when to safely discharge a woman who is not in active labor. Receiving care at the centers with higher referral frequency to telephonic nurse management for gestational diabetes mellitus was associated with decreased risk of macrosomic infant and increased postpartum glucose testing. Results of a national survey.
The project was designed and introduced to maximize the use of the clinical expertise possessed by a group of practice development midwives. Safe and thorough evaluation of the pregnant woman at term requires appropriate knowledge of the necessary components of maternal and fetal assessment. This telephone triage book is designed for use by professional nurses assessing and advising patients over the telephone on topics related to obstetrics and gynecology. Only literature during a selected time period was studied. Failure to recognize active labor is another liability pitfall. Discharging a pregnant woman from an obstetric triage unit without evidence of fetal well-being presents a risk.
However, most women with pregnancy complaints at 20-24 weeks gestation or greater are evaluated in an obstetric triage unit. It is designed to crystallize the professional's existing knowledge base and to provide clear guidance on handling a wide variety of patient situations which the triage nurse might need to work through. The greatest percentage of calls resulted in a recommendation to come to the hospital to be evaluated 25,894 41. Effective triage in an out-of-hospital birth center helps low-risk women avoid high-risk care. The protocols are arranged to lead the user from one step to the next. Its replicability in a range of settings still needs to be determined.
This tool, like the aforementioned tool of Paisley et al. At the request of private practice pediatricians in Denver, a metropolitan area-wide system was created to manage after-hours pediatric telephone calls and after-hours patient care. Reference lists of each article were scanned to locate any additional or supplemental sources. Governments at federal, state and local levels, have been making healthcare in these remote rural areas their focal point over the years so as to enable citizens in both rural and urban areas to have equal access to medical services and clinical healthcare despite the geographic isolation barriers but this effort has only been partly successful. This book offers suggestions for asking appropriate questions in a flowchart format to ascertain the assessment and severity of the problem and need for medical intervention. The purpose of this systematic review is to examine the literature on use of triage concepts in obstetrics during a 15-year time frame. Innovations in provider mix have added to the provision of continuity and safety in triage.
American Journal of Obstetrics and Gynecology, 209 4 , 287-293. Inclusion criteria: articles specifically related to obstetric triage or obstetric emergency practices in the hospital setting. Results: Women had an average maternal age of 28 years old, average weeks gestation was 27. Prior to 2007, there were no published obstetric acuity tools. The coordinated use of protocols, drills, simulations, and team training are effective ways in which to improve safety. A facility-specific time analysis of each point on the care pathway to complete principal steps from registration to discharge is a starting point.
Primary research in this area of practice is limited. This book is up to date with current electronic practices in the medical office and addresses these. Clinical Decision Aids Obstetric triage occurs in a dynamic, fast-paced atmosphere requiring rapid and accurate clinical assessment skills. We undertook this review because development of new triage facilities and role changes among providers in the obstetric triage setting have now altered how obstetric care is both assessed and provided. Avoiding the pitfalls of obstetric triage.
Triage of pregnant women in the emergency department: Evaluation of a triage decision aid. The Consolidated Omnibus Budget Reconciliation Act of 1985, 86. For example, a hospital in Denver with an 18-bed labor unit was constantly at full capacity until they opened a triage labor evaluation unit. Journal of Perinatology, 32 10 , 763-769. The lower values obtained with the telephone interview can be to the result of discomfort, anxiety, and the interference of external factors associated with the telephone approach Manning et al. The overwhelming need for standardized assessment in the form of decision aids is apparent in the publication of an entire book dedicated to narrative, obstetric, evidence-based protocols. There is a lot of good information for nurses to use as teaching tools when meeting with women for pregnancy visits or even menopausal visits.
Flow Diagram of Study Selection. Journal articles were retrieved primarily from nursing, advanced nursing practice journals, and medical journals. Ninety-three percent of the practices required the patient to decide whether the problem was emergent enough to require immediate notification of the on-call physician. Avoidance of treatment delays is key. Academic Medicine, 80 12 , 1094-1099. After-hours phoen calls necessitated an after-hours patient visit 20% of the time and generated one after-hours hospital admission out of every 88 calls.
Unlabelled: The telephone has become an indispensable method of communication in the practice of obstetrics. The credentialing committee in each hospital must approve that person to take on this role. This at-your-fingertips guide offers a wide range of current, evidence-based protocols, backed by proven patient-questioning techniques, quick-reference charts, and real-life patient scenarios. Now that such concepts as evidence-based guidelines, quality improvement interventions, and best practices are identified, randomized controlled trials would be recommended to test these practices. Most women were happy with the amount of time they waited in triage which appears to negate the need for appointments.
Indeed Salary Estimate Please note that all salary figures are approximations based upon third party submissions to Indeed. The need for a reliable and valid obstetric triage tool is crucial to eliminate time delays, not just patient to initial nursing assessment time, but patient to provider delays. Poor quality telephone consultations may lead to inappropriate admissions associated with increased health care or maternal costs, dissatisfaction from women, decreased job satisfaction for midwives, and raised maternal or perinatal risk. Delay in relaying urgency to the consultant, communication issues, or unclear consultation expectations all add to delays. The Guidelines for Perinatal Care outline the components of a comprehensive evaluation based on maternal-fetal status, when the responsible healthcare provider should be notified, and what should be documented in the medical record.