<p>Obstetric Telephone Triage</p>

Abstract

Objective Little is known about obstetric telephone triage: the methods used to prioritize the severity of symptoms of obstetric emergency and other unplanned care requests originating by telephone. In large-scale obstetric units, there is a need for an evidence-based triage guideline. The aim of this study was to develop an obstetric guideline for telephonic triage. Design, Setting and Participants A multi-phase multi-center study was performed with consecutive drafts of the triage guideline using four focus groups, four observations of training sessions and two expert consultations based on the Delphi method. The study was performed in ten hospitals in the Netherlands. The obstetric care professionals involved were gynecologists, midwives, nurses, doctor’s assistants, team managers and application managers. After each focus group, each observation and each expert consultation, an interpretative analysis was undertaken. Based on these analyses, the obstetric telephone triage guideline was drafted. Measurements and Results The designed guideline describes the primary symptoms presented, five prioritization categories and several descriptors. Consensus (>90%) was reached during the second expert consultation. Fifty-seven (91.9%) participants stated that the obstetric telephone triage guideline was clinically complete, correct, user-friendly and well designed, and 61 (98.4%) participants judged that the newly designed triage guideline was ready to use in daily practice. Key-Conclusions and Implications for Practice An evidence-based guideline for obstetric telephone triage was developed through a multi-phase multi-center study with all stakeholders. The guideline was found to be clinically complete, correct, well-designed and user-friendly. It provides a uniform and concrete basis for assessing the severity of the symptoms of obstetric emergency and other unplanned care requests originating by telephone. It also provides a good basis to further develop this evidence-based guideline for telephone triage by continuous registration of all calls.

Validation of Dutch Obstetric Telephone Triage System: A Prospective Validation Study

“…16,17 Current evidence suggests that the use of a multivariate approach with external validation can be seen as the highest achievable goal. 4,5,17 The results of this study, which was conducted in line with this approach, as well as (earlier) confirmation of DOTTS content validity 22 support this conclusion. Nevertheless, we need to stay critical about whether triage can be compared to screening tool studies.…”

“…Staff is given the opportunity to overrule the DOTTS urgency category. 22 …”

“…DOTTS was introduced in 2015 and is currently used in 25% of all Dutch hospitals (n=20/78). [20][21][22] The purpose of the present study was to determine the diagnostic and external validity of DOTTS in obstetric emergency care.…”

Reliability of Dutch Obstetric Telephone Triage

“…The Dutch Obstetric Telephone Triage System (DOTTS) aims to provide a uniform and practical triage system, and was developed through a multi-phase multi-center study in consultation with all stakeholders. 18 DOTTS is an evidence-based triage system, which uses presenting symptoms to classify the level of urgency. Recently published research into validity of DOTTS showed an acceptable diagnostic validity with room for improvement.…”

“…19 DOTTS was introduced in 2015 and is currently used in 26% of all Dutch hospitals (n=20/78). 18,20 The purpose of this study is to determine the reliability of DOTTS.…”