Advertisement

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

      This paper is only available as a PDF. To read, Please Download here.

      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

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Obstetrics & Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect