Implementation of a novel obstetric triage tool in the tertiary maternity hospital of Sierra Leone: A quality improvement project

Abstract

Triage tools have been shown to increase efficiency and accuracy of obstetric triage, but no published tools exist for low income settings. A novel guideline was developed and implemented in the tertiary maternity hospital of Sierra Leone. A triage system was implemented using a quality improvement approach. A novel triage guide, mentorship, improved patient flow and training were introduced. Prospective data was collected at three points over 5 months, capturing allocated triage category accuracy according to the system. The number of patients correctly triaged was 43.22% (n=51) before implementation, 81.82% (n=117) two weeks after training and 87.85% (n=159) two months after training. There was strong evidence (p=0.002) for the 44.63% (95% CI 34.50%-54.89%) increase in correct triage. Implementation of an obstetric triage system increased the amount of correctly triaged patients. Further research to evaluate patient outcomes, wait times and robust validation of this triage tool is needed.