Implementation of an Obstetric Triage Toolkit in a Rural Utah Hospital

Background: Rural Obstetric Registered Nurses (RNs) are required to have skills in all aspects of antepartum, intrapartum, and postpartum care. The low volume of births and triage patients make it challenging for rural RNs to develop and maintain adequate skills. The use of a standardized triage education program and the use of validated triage tools can decrease wait times, decrease cost, and increase quality care for obstetric triage patients. A quality improvement project was implemented at Sanpete Valley Hospital, a 19 bed, critical-access hospital located in rural Utah. They deliver approximately 120 babies yearly. The RNs who work at Sanpete Valley Hospital care for patients in all hospital areas. Fourteen RNs are specifically trained in women's services and care for patients in Obstetric Triage, Labor & Delivery, Recovery, Postpartum, and Newborn Nursery, as well as Medical-Surgical, Swing Bed, Outpatient, and Emergency Room patients. Methods: This quality improvement project was developed to help increase the knowledge and comfort levels of rural nurses with obstetric triage skills. Data was collected to identify the number and chief complaints of patients presenting for obstetric triage at a rural Utah hospital. Obstetric RNs were surveyed regarding education needs, knowledge gaps, and comfort levels with obstetric triage skills. The collected data was utilized to develop a rural obstetric triage toolkit. An obstetric triage skills activity was conducted at the hospital, which included hands-on training, case studies, and education regarding obstetric triage tools. The effectiveness of the toolkit was evaluated one month later with a post survey of the nurses that participated in the training. RNs were also surveyed regarding their comfort level with triage skills after the obstetric triage skills activity. Results: Eleven nurses completed both the pre and post surveys. Analysis of the data collected from pre and post surveys demonstrated a statistically significant improvement (p <.05) in the knowledge and comfort levels of the nurses for eight of the 25 measured questions. Two of the questions were not statistically significant (p >.05), and the remaining 15 questions were not able to be evaluated statistically due to a high number of matched data and a small sample size. However, the overall RN comfort level and knowledge for the majority of the measured obstetric triage skills were improved and appeared to be clinically significant. More than half of the RNs reported in the post-survey that they had forgotten the triage tools were available or did not have the opportunity to use them. Continuing education regarding the obstetric triage toolkit along with a longer time between the triage skills day and post-survey could help to improve exposure to triage toolkit materials and the knowledge and comfort level of the RNs. Conclusions: The obstetric triage toolkit and skills day appeared to be a valuable resource in increasing the knowledge and comfort level of rural RNs. Replication of this quality improvement project is needed to determine generalizability to other rural hospitals. Implementation of the toolkit with added continuing education and evaluation over time could improve obstetric triage outcomes for patients and staff.