Audit of Maternity Triage Times According to Code

Dr Tse Hieng Kong, Dr Karen Lincoln, Ms Sally Young

Introduction

This audit serves to analyse the compliance of the Maternal Assessment Unit (MAU) triage system based on adaptations on the recommendation of the Birmingham Symptoms Specific Obstetric Triage System (BSOTS).1

Background

Many hospitals across the UK have been utilising triage systems to optimise appropriate timely assessment of the increasing numbers of patients attending. There was concern that standards were particularly difficult to meet at certain times. Patients presented to MAU were triaged into different colour codes: red, amber, yellow and green based on the maternal history and observations. Each code had a different pathway and time requirement.1

Methods

Data were collected prospectively using proformas in the MAU. Assessing parameters include the time of arrival, whether initial triage occurred within 15 minutes, whether triage by midwife occurred within the given code time and whether doctors' review occurred within code time. A sample size of 535 was collected within 3 weeks.

Results

The data were stratified into 3 hourly intervals from midnight. Out of 535 patients who presented to MAU, only 283 patients (53%) were triaged within 15 minutes of arrival. Admissions peaked during 09.00 - 11.59 where 133 admissions were recorded. This led to a backlog of patients being triaged within 15 minutes of arrival, where only 38 patients (33%) were triaged timely between 15.00-17.59, accounting for the poorest compliance in the day. However, 475 patients (89%) were seen timely by the midwifery team based on the triage code. Data collected showed 178 of 291 patients (61%) were seen by a doctor within the triage code.

Conclusion

We have identified reasonable compliance with the triage system regarding the time for midwives to see women after triage. Improvement is required for doctors to review in time. The potential causes are inappropriate referrals, no designated doctor and lack of midwives. Interventions include changing midwifery shift patterns, designated midwives to answer phone calls, developing an escalation policy, including triage code in handovers, the allocation of senior doctors in MAU and appropriate non-obstetric problems to be seen in Same Day Emergency Care (SDEC). We plan to quadrangulate evidence by including additional audits for the completion of triage booklets and patient-staff satisfaction.