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

Area of Science:

• Obstetrics and Gynecology
• Public Health
• Healthcare Management

Background:

• Referral hospitals in low-resource settings face challenges managing increased patient loads for institutional delivery.
• Maternal morbidity and mortality reduction strategies require efficient patient management systems.

Purpose of the Study:

• To assess the impact of an obstetric triage improvement program on reducing hospital-based delays.
• To evaluate the effectiveness of an Active Implementation Framework in a referral hospital in Accra, Ghana.

Main Methods:

• A 5-year intervention using an Active Implementation Framework to introduce and monitor obstetric triage capabilities.
• Collected baseline data on patient assessment delays and compared it with data post-intervention, including waiting times and care plan documentation.
• Established a dedicated obstetric triage pavilion with trained midwives.

Main Results:

• Reduced median patient waiting time from 40 minutes to 5 minutes (p<0.001).
• Eliminated delays in admission and disease acuity assessment.
• Increased care plan documentation from 51% to 96%.

Conclusions:

• Obstetric triage, when properly implemented, significantly reduces delays in busy, low-resource hospitals.
• The program demonstrated sustained success under local leadership, improving patient flow and care quality.