Task shifting: a key aspect to improving care for women at risk of preterm birth

Until April 2021, women presenting to maternity triage with symptoms of threatened preterm labour (TPTL) and/or preterm premature rupture of the membranes (PPROM) were triaged by a doctor. Depending on the acuity on the labour ward, women in triage often had a long wait for a doctor's review. These delays create anxiety for women and impair the capacity of triage midwives to care for other women.

The Plan-Do-Study-Act method of quality improvement was used for this project. 3 months prior to the intervention, the baseline assessment was women's wait time for medical review when presenting with TPTL and/or PPROM.

Triage midwives were trained in performing speculum examination on preterm (<37 weeks' gestation) women to allow quicker review. Waiting time for review by a midwife vs doctor was compared using data collected between January and December 2021.

88 eligible women were identified. 44 cases (intervention group) had their initial assessment by the triage midwife, while 44 cases (control group) had their initial assessment by a doctor. The mean waiting time between arrival and performance of quantitative fetal fibronectin (qfFN) in the intervention group was 67 min (SD=42.7), compared with 127 min (SD=61.2) in the control group (p<0.001). However, there was no significant difference in the waiting time between arrival and discharge/admission.

Women presenting with symptoms of TPTL are reviewed on average twice as quickly by the triage midwife compared with a doctor, allowing a quick reassurance for those where TPTL/PPROM has been excluded. However, the overall waiting time in triage was similar, as women in our unit currently need a doctor's review before discharge.