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Impact of Implementation of the Maternal Fetal Triage Index on Patients Presenting with Severe Hypertension

Published:June 10, 2022DOI:https://doi.org/10.1016/j.ajog.2022.06.006
Impact of Implementation of the Maternal Fetal Triage Index on Patients Presenting with Severe Hypertension
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      Structured Abstract:

      Background

      Severe hypertension remains one of the leading preventable causes of maternal mortality in the United States. Timeliness to response to severe hypertension in pregnancy is a critical quality indicator tracked by state and national organizations. We hypothesized that implementation of the Maternal Fetal Triage Index, a validated acuity tool, would improve care performance in women with severe hypertension in an urban, inner-city hospital setting.

      Objective

      Our objective was to assess the impact of the Maternal Fetal Triage Index on the management of women presenting with severe pre-eclampsia diagnosed by severe hypertension as measured by time to provider assessment, administration of magnesium sulfate, and immediate administration of acute antihypertensives.

      Study Design

      This was a prospective, observational study of pregnant women presenting to labor and delivery triage unit with severe pre-eclampsia diagnosed by severe hypertension delivering at a large urban inner-city academic facility before (Epoch 1: January 1, 2019- December 31, 2019) and after (Epoch 2: March 1, 2021- September 31, 2021) implementation of the Maternal Fetal Triage Index. Baseline outcomes of time to assessment, time to magnesium sulfate prophylaxis, and time to antihypertensive medication administration prior to implementation of the Maternal Fetal Triage Index were assessed. The Maternal Fetal Triage Index tool was implemented on March 1, 2021, following standardized education in 2020 for all triage nurses, unit technicians, healthcare unit coordinators, and healthcare providers. Time to assessment, administration of magnesium sulfate prophylaxis, and time to antihypertensive administration following implementation of the Maternal Fetal Triage Index were compared with pre- Maternal Fetal Triage Index measures. Statistical analysis included Wilcoxon rank sum test with P< 0.05 considered significant when comparing epoch 1 to epoch 2.

      Results

      A total of 370 patients were admitted with severe hypertension in 2019 prior to the use of the Maternal Fetal Triage Index, and 254 patients were admitted with severe hypertension in 2021 after the Maternal Fetal Triage Index was implemented. There were no differences between epochs across baseline characteristics including age, race/ethnicity, parity, and body mass index. After the Maternal Fetal Triage Index was implemented, time to provider assessment was significantly improved, from median time of 44 [0, 65] minutes in epoch 1 to 17 [0, 39] minutes, P<0.001 in epoch 2. Time from arrival to magnesium sulfate prophylaxis was also significantly faster with median time of 161 [109, 256] minutes in epoch 1 vs. 127 [85, 258] minutes, P=0.001 in epoch 2. There was also a decrease in time from arrival to antihypertensive medication administration for severe blood pressures after implementation of the Maternal Fetal Triage Index (101[61, 177] minutes vs 66 [35, 203] minutes, P<0.001).

      Conclusions

      Implementation of the Maternal Fetal Triage Index at a large urban inner-city hospital was associated with improved timeliness of assessment and treatment of women with severe hypertension. The Maternal Fetal Triage Index is a viable mechanism to improve efficiency among triage units- specifically in the management of severe hypertension.

      Key words

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      Article Info

      Publication History

      Accepted: June 3, 2022
      Received in revised form: May 25, 2022
      Received: March 3, 2022

      Publication stage

      In Press Journal Pre-Proof

      Footnotes

      Disclosures: There are no disclosures.

      No source of financial support.

      Portions of this abstract were presented as a poster presentation (#138) at the 42nd annual pregnancy meeting of the Society for Maternal Fetal Medicine, Virtual meeting Jan 31-Feb 5, 2022.

      AJOG at a Glance:

      A. Why was this study conducted?

      This study was conducted to assess the impact of the Maternal Fetal Triage index on time to assessment and time to intervention in patients with severe hypertension in pregnancy.

      B. What are the key findings?

      Time from arrival to assessment, prophylaxis with magnesium sulfate, and administration of antihypertensives significantly improved with implementation of the Maternal Fetal Triage Index in patients with severe hypertension in pregnancy.

      C. What does this study add to what is already known?

      The Maternal Fetal Triage Index can improve efficiency in assessment and management in patients with severe hypertension in pregnancy in an urban, inner- city hospital setting.

      CRediT author statement

      Eva Hoffmann, MD: Conceptualization, Methodology, Investigation, Writing- Original draft preparation, Reviewing and Editing, Project administration. Kristie Wilburn-Wren, MD Investigation, Writing- Reviewing and Editing, Shena J. Dillon, MD: Conceptualization, Methodology, Investigation, Data curation, Writing- Reviewing and editing Amarily Barahona, DNP, CNM, APRN, C-EFM Conceptualization, Methodology, Writing- Reviewing and Editing Donald D. McIntire, PhD: Investigation, Data Curation, Formal analysis, Resources, Visualization David B. Nelson, MD: Supervision, Conceptualization, Methodology, Writing- Reviewing and Editing.

      Identification

      DOI: https://doi.org/10.1016/j.ajog.2022.06.006

      Copyright

      © 2022 Elsevier Inc. All rights reserved.

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