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Implementing a triage system to reduce waiting time and prioritize care for high-risk obstetric patients in a Ghanaian regional hospital
Abstract Number: SA-37
Abstract Type: Original Research
Introduction: There is limited data regarding obstetric triage in low-resource settings. In Ghanaian childbirth facilities, a first-come, first-serve approach is standard care, thus creating delay for women presenting with hemorrhage, pre-eclampsia and other dangerous conditions. At Ridge Regional Hospital in Accra, approximately 70% of women are referred and frequently wait for long periods before assessment. It is important to quickly prioritize at-risk patients through a triage process. A collaboration began in 2012 between Ridge and Kybele, Inc. to measure delay and to design and employ an obstetric triage system.
Methods: Following institutional review board approval, obstetric triage data was collected at Ridge Hospital to determine referral patterns and timeliness of care. Patient demographic information, work flow patterns, care practices and compliance to local guidelines were assessed. A 2-day triage training program was developed to provide a structured approach to clinical assessment, risk recognition, decision making, and communication employing a joint problem solving approach. Implementation of quality improvement ideas locally generated by course participants was monitored by hospital midwives selected to be clinical champions and role models. Post-training data was collected to evaluate the recognition of risk and timeliness of care.
Results: Pre-and post-training triage data were collected September-November 2012 and December 2014, respectively. Sixty-two midwives completed triage training over 12 months. Colored wrist bands (red, yellow and green) were introduced to identify high, medium and low risk patients. In 2014, quantitative and qualitative wrist band use was 92% and 93%, respectively. A diagnosis and plan were recorded in 85% and 82% of audits. The mean±SD [IQR] wait from arrival until assessment decreased from 88±155[15-100)] min to 63±83[12.5-78] min (p<0.05). Maximum wait time was reduced from 1 day 2.5 hours to 8 hours 50 min.
Conclusion: It is important to quickly and correctly triage high-risk obstetric patients to reduce poor maternal and newborn outcomes. The triage training program developed at Ridge Hospital will be scaled to four other regional hospitals in Ghana through an extended collaboration. Major infrastructural improvements were made following the program and final data collection is in progress.