Implementation, effectiveness, and barriers of obstetric triage in reducing waiting time: a scoping review

The assessment of a pregnant woman typically begins at obstetric triage, where healthcare providers evaluate whether life-altering decisions are necessary for the woman and her unborn baby. This scoping review aimed to assess the lack of comprehensive evaluation of across diverse settings of the evidence on the effectiveness, implementation, and barriers to the successful implementation of obstetric triage during pregnancy and childbirth.

The Arksey and O'Malley scoping review methodological framework and Joanna Briggs Institute Reviewers' Manual were applied to conduct the scoping review. The Population, Concept, and Context strategy (PCC) was used to develop the review questions, eligibility criteria, and research strategy, incorporating findings from both quantitative and qualitative research. Preferred Reporting Items for Systematic Reviews and Meta-analyses: Extension for Scoping review (PRISMA-ScR) was implemented. A scoping review search was conducted using four databases by specific key words for example: "pregnant woman" OR "postnatal woman" AND "triage" OR "obstetric emergency service" OR "health facility" AND "delivery" OR "childbirth" OR "obstetric" OR "prenatal care" OR "parturition" OR "pregnancy" OR "maternal health services" OR "perinatal care" OR "postnatal care". Further additional studies or references were culled from included primary studies to identify relevant studies that were missed in the initial search.

The search strategy generated an initial list of 622 studies of which 15 studies were included. The findings revealed that the implementation of obstetric triage can substantially reduce delays in getting care (delay 3) during birth. The barriers within the department which hindered the successful implementation of obstetric triage included shortages of staff and space, burnout and fatigue among health professionals, inadequate knowledge, resistance to change, lack of commitment and responsibility, unclear task descriptions, insufficient supplies, and deficient communications system.

Our findings underscore that the effective implementation of triage was linked to reduced costs, such as decreased waiting times for women, across six countries. However, identified factors frequently hampered the successful implementation of obstetric triage during pregnancy and childbirth. Given that implementing obstetric triage can substantially reduce delays in getting care during pregnancy and childbirth, linked to reducing costs, and the identified barriers need to be addressed.