Addressing the third delay: implementing a novel obstetric triage system in Ghana

Owen, Medge D.; Srofenyoh, Emmanuel; Ramaswamy, Rohit; Bryce, Fiona; Floyd, Liz; Olufolabi, Adeyemi J.; Tetteh, Cecilia

doi:10.1136/bmjgh-2017-000623

Cited by 35 publications

(22 citation statements)

References 21 publications

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“…Maternal fetal triage index is a high quality acuity tool for enhancement of patient health care and its validity has been established in studies 11 . Triage is a clinical assessment that sorts out patients for early diagnosis and treatment thus it is a risk management system employed in all busy emergency departments of hospital 12 . Considering the overcrowding and resource constraints in low and middle income countries extending it to the obstetric services would definitely improve services and satisfaction by prioritizing patients and reduce liability and complaints due to risk stratification.…”

Section: Discussionmentioning

confidence: 99%

Role of Obstetric Triage in Improving Patient Health Care at CMH Kharian-a Comparitive Study

Ansari

Akram

Khalil

et al. 2020

PAFMJ

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Objective: To evaluate the up gradation of obstetric patient care by using obstetrics-specific triage acuity tool. Study design: Comparative prospective study Place and duration of study: This study was conducted at obstetrics unit of combined military hospital Kharian from June 2018 to Dec 2018. Methodology: Pregnant patients were triaged and prioritized according to Maternal fetal triage index (MFTI) into five levels. Primary outcome was time to triage and management plan documentation. Patient and health care provider satisfaction was evaluated using Likert’s scale before and after implementation of MFTI. Data was collected and expressed in frequencies and percentage. Chi square test was applied for association between before and after triage intervention variables, and a P value of 0.05 was considered significant. Results: A total of 1000 pregnant patients referred to OPD were enrolled, 500 patients before and 500 after implementation of MFTI. Patients were prioritized using MFTI system,10(2%) patients category 1 while category 2,3,4,and 5 were 28(5.6%),68(13.6%),150(30%) and 244(48.8%) respectively. There was significant reduction in waiting time from 35.4±8.2 minutes to18.2±6.5 p=<0.002. Hospital complaints reduced significantly from 25(5%) in before group to 4(0.8%) P=<0.001 after application of obstetric triage. Conclusion: Obstetric triage by MFTI focuses on the urgency and symptoms at presentation to decide further disposal. The usage of a systematic and properly developed triage system produces improvement in patient care. The results of study not only highlight the importance of usage of a triage system but also explore its usefulness and improvement in outcomes in a developing country like Pakistan.

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Section: Discussionmentioning

confidence: 99%

Role of Obstetric Triage in Improving Patient Health Care at CMH Kharian-a Comparitive Study

Ansari

Akram

Khalil

et al. 2020

PAFMJ

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“…obstetric triage protocol intervention, with timeliness of assessment as the clinical intervention outcome of interest. Implementation resulted in a reduction in median waiting time from arrival to assessment from 40 to 5 min [11].…”

Section: Contribution To the Fieldmentioning

confidence: 99%

“…The potential consequences of this delay can be severe for women with high-risk or otherwise complicated pregnancies and their infants. Therefore, quickly and accurately assessing women upon their arrival to the facility and developing tailored, risk-based care plans constitute an important first step in assuring positive outcomes [11].…”

Section: Introductionmentioning

confidence: 99%

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A protocol for evaluating a multi-level implementation theory to scale-up obstetric triage in referral hospitals in Ghana

et al. 2020

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Background: Ghana significantly reduced maternal and newborn mortality between 1990 and 2015, largely through efforts focused on improving access to care. Yet achieving further progress requires improving the quality and timeliness of care. Beginning in 2013, Ghana Health Service and Kybele, a US-based non-governmental organization, developed an innovative obstetric triage system to help midwives assess, diagnosis, and determine appropriate care plans more quickly and accurately. In 2019, efforts began to scale this successful intervention into six additional hospitals. This protocol describes the theory-based implementation approach guiding scale-up and presents the proposed mixed-methods evaluation plan. Methods: An implementation theory was developed to describe how complementary implementation strategies would be bundled into a multi-level implementation approach. Drawing on the Interactive Systems Framework and Evidenced Based System for Implementation Support, the proposed implementation approach is designed to help individual facilities develop implementation capacity and also build a learning network across facilities to support the implementation of evidence-based interventions. A convergent design mixed methods approach will be used to evaluate implementation with relevant data drawn from tailored assessments, routinely collected process and quality monitoring data, textual analysis of relevant documents and WhatsApp group messages, and key informant interviews. Implementation outcomes of interest are acceptability, adoption, and sustainability. Discussion: The past decade has seen a rapid growth in the development of frameworks, models, and theories of implementation, yet there remains little guidance on how to use these to operationalize implementation practice. This study proposes one method for using implementation theory, paired with other kinds of mid-level and program theory, to guide the replication and evaluation of a clinical intervention in a complex, real-world setting. The results of this study should help to provide evidence of how implementation theory can be used to help close the "know-do" gap.

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“…50 In response, a novel obstetric triage system has been introduced, successfully reducing the delay from arrival at the referral centre to the first assessment by a midwife. 51,52 Strategies to identify critically ill patients, enable early and appropriate management and thus prevent avoidable critical care admissions, are paramount. These strategies need to be clinically based and not rely on expensive diagnostic modalities, monitoring, and therapeutic options that are mostly not available in RLS.…”

Section: Challenges To the Provision Of Maternal Critical Care In Resmentioning

confidence: 99%

Maternal critical care in resource-limited settings. Narrative review

Vasco

Pandya²,

Dyk

et al. 2019

International Journal of Obstetric Anesthesia

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Maternal critical care reflects interdisciplinary care in any hospital area according to the severity of illness of the pregnant woman. The admission rate to intensive care units is below 1% (0.08-0.76%) of deliveries in high-income countries, and ranges from 0.13% to 4.6% in low-and middle-income countries. Mortality in these patients is high and varies from 0% to 4.9% of admissions in highincome countries, and from 2% to 43.6% in low-and middle-income countries. Obstetric haemorrhage, sepsis, preeclampsia, human immunodeficiency virus complications and tropical diseases are the main reasons for intensive care unit admission in low middle-income countries. Bedside assessment tools, such as early warning scores, may help to identify critically ill patients and those at risk of deterioration. There is a lack of uniformity in definitions, identification and treatment of critically ill pregnant patients, especially in resourcelimited settings. Our aims were to (i) propose a more practical definition of maternal critical care, (ii) discuss maternal mortality in the setting of limited accessibility of critical care units, (iii) provide some accessible tools to improve identification of obstetric patients who may become critically ill, and (iv) confront challenges in providing maternal critical care in resource-limited settings. To improve maternal critical care, training programmes should embrace modern technological educational aids and incorporate new tools and technologies that assist prediction of critical illness in the pregnant patient. The goal must be improved outcomes following early interventions, early initiation of resuscitation, and early transfer to an appropriate level of care, whenever possible.

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Addressing the third delay: implementing a novel obstetric triage system in Ghana

Cited by 35 publications

References 21 publications

Role of Obstetric Triage in Improving Patient Health Care at CMH Kharian-a Comparitive Study

Role of Obstetric Triage in Improving Patient Health Care at CMH Kharian-a Comparitive Study

A protocol for evaluating a multi-level implementation theory to scale-up obstetric triage in referral hospitals in Ghana

Maternal critical care in resource-limited settings. Narrative review

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