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Implementing risk-appropriate maternity care-based triage model at a tertiary care teaching institute: an
Gowri Dorairajan1, Anish Keepanasseril2, Samraj Senthil Kumar3
1Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
Insights
A new risk-appropriate triage model reduced hospital births by 41%, improving care quality for high-risk pregnancies. This system enhanced patient outcomes and resource management in maternity services.
Area of Science:
- Maternal Health
- Healthcare Management
- Public Health Interventions
Background:
- Regional perinatal center experienced a surge in annual births, nearing 19,000 in 2019, leading to resource strain.
- COVID-19 pandemic restrictions reduced low-risk births, prompting the development of a new triage system.
- The study aimed to implement and evaluate a risk-appropriate triage model for maternity care.
Purpose of the Study:
- To design and implement a risk-appropriate triage model referral system.
- To examine the impact of the triage model on birth rates and quality of care.
- To improve resource allocation and patient management in a high-volume perinatal center.
Main Methods:
- Analysis of childbirth data from 2019 and district demographics.
- Collaborative discussions with district health administrators on triage implementation.
- Antenatal clinic triage by a dedicated team, referring cases to appropriate facilities.
- Utilized WhatsApp for information sharing on referred and transferred patients.
- Assessed impact via changes in birth numbers, risk proportions, quality indicators, and staff feedback.
Main Results:
- Average monthly births decreased from 1530 (2019) to 900 (2023) post-triage implementation (Dec 2022).
- Quality indicators like stillbirth and scar rupture rates declined; C-section rates increased from 20% to 30%.
- Observed improved staff satisfaction, a shift towards higher-risk pregnancies, and reduced bed occupancy, averting overcrowding.
Conclusions:
- A 'risk-appropriate maternity care-based triage model' is feasible and effective.
- The model successfully reduced low-risk births at the tertiary care institute.
- Implementation improved the quality of care for high-risk women within the system.
Background:
The annual births in our hospital (a regional perinatal centre for the southeastern coastal region) had increased to nearly 19 000 in 2019, straining the resources. Reduced low-risk childbirths due to the restrictions during the COVID-19 pandemic gave us an impetus to design and implement a risk-appropriate triage model referral system. We report its implementation process and examine its effect on birth rates and quality of care.
Methods:
Initially, the data on childbirths (2019) and the districts where the majority belonged were analysed. We discussed the need for triaging and the implementation process with these district health administrators. In the antenatal clinic, a dedicated team triaged and referred new cases to risk-appropriate facilities near their homes. Using WhatsApp groups, information about those referred back and the critically ill transferred to our hospital was shared. The impact of model implementation was assessed by the change in the number of births, proportion of high-risk cases, quality indicators and feedback from health workers.
Results:
The average number of childbirths per month decreased from 1530 in 2019 to 900 in 2023 after the implementation of triage on 15 December 2022. The quality indicators, such as stillbirth and scar rupture, declined after implementation, but caesarean deliveries rose from 20% to 30%. Better satisfaction among personnel and a change in the pattern to more high-risk pregnancies were noted; there was a reduction in bed occupancy rates, averting overcrowding.
Conclusion:
A 'risk-appropriate maternity care-based triage model' could be implemented, reducing low-risk births and improving the quality of care for high-risk women in tertiary care institutes.
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