Triage of Pregnant Women in the Urgent Care Setting: A Quality Improvement Initiative

Background: Pregnant women often seek care at urgent care (UC) facilities over more appropriate settings designed for tailored triage like Obstetric Emergency Services (OBES) at University of Utah Medical Center. Improper triage and poor interdepartmental transfer of pregnant women has been strongly linked to delayed care which leads to risk of increased maternal and fetal mortality as well as antepartum complications. The purpose of this project is to identify gaps in nurse Obstetric (OB) triage knowledge to further improve safe triage and handoff practices for pregnant women and their fetuses. Methods: This quality improvement project fills existing knowledge gaps and improves the obstetric triage process by nurses in UC. The data in this project was gathered using survey methods. Prior to the intervention; demographic information, baseline comfort, and education level via pre-survey were collected. The education materials were constructed based on national safety guidelines for OB triage and assembled into a toolkit for staff to utilize. The materials were disseminated via small group and one-on-one teaching. The toolkit included a quick documentation tool in the electronic medical record and education materials that were left on the department's intranet site for readily available reference. One-month post-intervention, a survey was used to measure education retention, self-reported comfort level on use of the guidelines, and the number of times the nurses were able to implement the project. Data on feasibility, usability and sustainability of the project were also collected. Results: Demographic information collected was used to describe staff, setting, and determine the length of time worked in urgent care. Of the 9 nurses that underwent the education intervention, 7 nurses completed both pre and post-surveys. Post-intervention data collection reported an overall improvement of obstetric knowledge by 35% (n=9) by nurses receiving the education intervention. Reported overall comfort with OB triage, familiarity with OBES, confidence with documentation and hand-off improved significantly between baseline and follow up survey post education intervention. However, when evaluating adequacy of OB triage training on post-survey, only 3 out of 7 RNs felt the brief training was adequate and further adaptation to new employee orientation was helpful. Conclusions: The educational presentation and toolkit are valuable resources to aid in improving OB triage comfort and knowledge improving the triage process of pregnant women in the UC setting. Replication of this quality improvement project in other UC clinics is needed to determine if similar rates of OB triage comfort exist in similar settings with larger groups of participants and more robust training courses. However, based on survey results, continued training is necessary and appreciated by staff.