Acuity Assessment in Obstetrical Triage

Area of Science:

• Obstetrics and Gynecology
• Healthcare Quality Improvement
• Nursing Practice

Background:

• Standardized assessment tools are crucial for effective obstetric triage.
• Existing tools may lack comprehensive validation or inter-institutional applicability.
• The Obstetrical Triage Acuity Scale (OTAS) was developed to address these needs.

Purpose of the Study:

• To evaluate the inter-rater reliability (IRR) and intra-rater reliability (ITR) of the Obstetrical Triage Acuity Scale (OTAS) in tertiary and community hospitals.
• To establish the validity of OTAS by correlating acuity levels with resource utilization.
• To present the first revision of OTAS, incorporating expert recommendations.

Main Methods:

• Nurses from three hospitals (tertiary and community) assessed clinical scenarios using OTAS for IRR.
• A subset of nurses at the tertiary site were retested after nine months to determine ITR.
• Validity was assessed by correlating OTAS acuity levels with laboratory tests, ultrasound use, nursing workload, and provider attendance.

Main Results:

• OTAS demonstrated significant and comparable IRR across different hospital settings.
• Significant ITR was confirmed in a repeated assessment cohort.
• OTAS acuity levels showed significant correlations with various resource utilization measures, including investigations, workload, and provider attendance.
• The scale was revised with four new acuity modifiers.

Conclusions:

• OTAS is the first obstetrical triage scale with proven reliability and validity.
• It facilitates standardized acuity assessments within and between healthcare institutions.
• The scale supports improved patient care and flow management based on acuity.