Creating a patient classification system: one birth center's experience in the triage process

Adequate nurse staffing is crucial to the provision of quality maternity care in the rapidly changing health care market including the triage of obstetric patients. The mandate for cost-efficient services must be balanced by the triage of health team members who are essential to safe and effective operations in the inpatient perinatal setting. The transformation of traditional perinatal units to single-site maternity care centers requires the development of creative staffing designs that permit the expeditious allocation of human resources in a cost-effective manner. Creating an acuity-based patient classification system for a single-site unit is a challenging task. The authors describe the process of creating a patient classification system when a new unit, The Birth Center, was opened at San Francisco General Hospital Medical Center. The unit combined the staff and patient populations of a labor and delivery unit with an antepartum-postpartum-gynecology unit and included a triage room for evaluation of pregnant clients. The two units had different modalities for budget and staffing. An activity study was conducted to determine unit and staff activities. A patient classification system was created for the single-site maternity unit, which allowed for acuity-driven staffing.