Improving Satisfaction with Care and Reducing Length of Stay in an Obstetric Triage Unit Using a Nurse-Midwife-Managed Model of Care.

Journal of midwifery & women's health (Impact Factor: 1.13). 03/2013; DOI: 10.1111/j.1542-2011.2012.00239.x
Source: PubMed

ABSTRACT Introduction: A quality improvement project was initiated at a tertiary-care center in a suburban area of the northeastern United States to determine whether length of stay and patient satisfaction in an obstetric triage unit could be improved by using a certified nurse-midwife (CNM) to manage and organize care in the triage unit. Methods: Patient satisfaction was measured using a previously validated instrument that consisted of 6 items using a 6-point Likert-type scale. The items measured patient satisfaction with: wait time for provider, information given, amount of time spent with provider, length of visit, overall care received, and overall triage experience. Patient satisfaction was measured before (n = 37) and after implementing CNM-managed care (n = 66) in an obstetrical triage unit. Length of stay in the triage unit was measured during standard care (n = 121) and after the implementation of CNM-managed care (n = 151) by recording the number of minutes women spent in the triage unit. Results: Participants in the CNM-managed care group reported increased patient satisfaction with care in 5 of the 6 aspects of satisfaction that were measured, including wait time for provider (P= .01), time spent with provider (P= .01), length of visit (P= .04), overall care received (P= .04), and overall triage experience (P= .01). The length of stay was significantly shorter for the women in the CNM-managed group (mean = 94.7 minutes; standard deviation [SD] 50.1) than for the women in the standard care model (mean = 122 minutes; SD = 66.8; P < .01). Discussion: The findings from this project suggest that a CNM-managed obstetric triage unit can improve satisfaction with care during the triage experience and reduce length of stay in the triage unit.

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    ABSTRACT: Background: Triage concepts have shifted the focus of obstetric care to include obstetric triage units. The purpose of this systematic review is to examine the literature on use of triage concepts in obstetrics during a 15-year time frame.Methods: A systematic review was completed of the obstetric triage literature from 1998 to 2013 using the electronic online databases from PubMed, CINHAL, Ovid, and Cochrane Library Reviews within the English language. Reference lists of articles were reviewed to identify other pertinent publications. Both peer-reviewed and non-peer-reviewed documents were used. Inclusion criteria: articles specifically related to obstetric triage or obstetric emergency practices in the hospital setting. Exclusion criteria included: manuscripts that focused on general, nonobstetric emergency and triage units, telephone triage, out-of-hospital practices, other clinical conditions, and references outside the time frame of 1998-2013.Results: Key categories were identified and include: legal issues and impact of Emergency Medical Treatment and Active Labor Act (EMTALA); liability pitfalls; risk stratification (acuity tools); clinical decision aids; utilization, patient flow, and patient satisfaction; impact on interprofessional education and advanced nursing practice; and management of selected clinical conditions. Components of a best practice model for obstetric triage are introduced.Conclusion: Seven key triage categories from the literature were identified and best practices were developed for obstetric triage units from this systematic review. Both can be used to guide future practice and research within obstetric triage.
    MCN The American Journal of Maternal/Child Nursing 06/2014; 39(5). DOI:10.1097/NMC.0000000000000069 · 0.84 Impact Factor


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May 19, 2014