Implementation of the Maternal Fetal Triage Index to Improve Obstetric Triage

Objective: To compare implementation and effectiveness of the Maternal Fetal Triage Index (MFTI) in an urban academic hospital and a suburban private hospital. Design: A pre-/postintervention, hybrid Type 3 effectiveness-implementation study design was used. Data collected 2 months preceding the intervention served as preintervention data. The MFTI was implemented for 2 months at each hospital, generating postintervention data for comparison. The reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework was used to guide the implementation and evaluation. Setting/Local Problem: The volume of and various reasons women present for emergency evaluation on maternity units requires systematic triage. Women are typically seen based on when they arrive with limited exceptions, rather than triaged according to acuity, hindering the responsiveness needed to address potentially life-threatening conditions. The term women refers strictly to the biological and anatomic female sex characteristics that are required for intrauterine pregnancy. Participants: Medical records of pregnant women presenting for emergency evaluation and physician and nurse documentation were used for data collection. Interventions/Measurements: The intervention was triage with the MFTI, acuity level assignment, and screenings within predetermined time frames. Fidelity to protocols and the timeliness of nurse contact and screenings were measured. Results: Implementation across all shifts was associated with greater adherence. The MFTI was associated with a significant reduction in the time from arrival to registered nurse contact for all acuity levels and time to screening foracuity levels overall, as well as for “prompt” and “urgent” acuities independently. Conclusion: This project provides a benchmark for quality obstetric triage and a roadmap for further exploration of the MFTI's clinical impact. Through systematic triage, the MFTI establishes effective prioritization and safety, supports favorable health outcomes, and is becoming the standard of practice for obstetric triage.