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Identifying workload and types of admissions in an obstetric triage department
  1. RA Samangaya,
  2. MK Whitworth,
  3. J Mason,
  4. A Brockbank,
  5. J Gillham
  1. St Mary's Hospital, Manchester, UK

Abstract

Introduction Royal College of Obstetricians and Gynaecologists recommendations are that every pregnant woman attending A&E for other than minor injuries should be seen by a midwife or obstetrician. In the UK, obstetric departments are frequently isolated from A&E. Consequently, in the last decade obstetric triage departments (OTDs) have developed. The only published literature on OTDs comes from the US where roles are to determine whether a woman is in labour. In the UK, remits are wider with obstetric, medical or surgical problems.

Method Prospective survey conducted during March 2009 to determine workload, staffing and admissions in a tertiary referral hospital.

Results There were 751 attendances; mean 24.2 per 24 h (range 13–32). Midwives assessed women in a mean of 15 m (range 0–3 h 30 m). Mean number of telephone calls per shift was 13 (range 4–24). Staffing was below the recommended level on 44% of shifts. Peak time for attendance was 11:00. 57% of women were in labour; 16% suspected ruptured membranes; 11% abdominal pain; 8% vaginal bleeding; 7% reduced fetal movements. Mean time spent in OTD was 2 h 8 m (range 2 m–10 h 30 m). 39.8% were reviewed solely by a midwife. Of those requiring medical review, mean wait was 1 h 7 min (range 0–4 h 25 m). 42% of women went home from the OTD, 22% admitted to an antenatal ward and 24% to delivery suite.

Conclusion This is the first study to describe workload of an OTD and highlights the massive flow of patients through such a department. The study concluded that an obstetric specific triage system is necessary to optimise patient flow.

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