Improving Timeliness of Obstetrical Triage Throughput in an Urban Tertiary Care Hospital

Obstetrical triage units function like emergency departments with unpredictable volumes that affect the timely evaluation and treatment of patients and lead to longer wait times, delays in care, and longer length of stay (LOS).

The aim of this quality improvement initiative was to decrease the length of stay (LOS) of obstetrical triage patients by 20% through the utilization of nurse-driven orders, improved communication, and patient engagement.

Rapid cycle quality improvement using four plan-do-study-act cycles was utilized. Primary interventions were a patient decision tool, nurse-driven orders, a hypertension care algorithm, and team huddles. Data were analyzed using run charts to evaluate the impact of interventions on outcomes.

Overall mean LOS for all patients (N = 654) was decreased by 26%. Most patients were satisfied with the patient decision tool (M = 4.45 on a 5-point Likert scale). The utilization of nurse-driven orders facilitated a decrease in mean LOS for hypertensive patients (N = 59) of 12%.

Throughput in obstetrical triage is affected by many factors including availability of test results, practice styles of providers, and availability of beds.

Nurses can influence the length of time a patient remains in triage through the use of nurse-driven orders and improved communication with providers.