https://orcid.org/0000-0001-8631-2352
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Abstract
Objective
Little is known about obstetric telephone triage: the methods used to prioritize the severity of symptoms of obstetric emergency and other unplanned care requests originating by telephone. In large-scale obstetric units, there is a need for an evidence-based triage guideline. The aim of this study was to develop an obstetric guideline for telephonic triage.
Design, Setting and Participants
A multi-phase multi-center study was performed with consecutive drafts of the triage guideline using four focus groups, four observations of training sessions and two expert consultations based on the Delphi method. The study was performed in ten hospitals in the Netherlands. The obstetric care professionals involved were gynecologists, midwives, nurses, doctor’s assistants, team managers and application managers. After each focus group, each observation and each expert consultation, an interpretative analysis was undertaken. Based on these analyses, the obstetric telephone triage guideline was drafted.
Measurements and Results
The designed guideline describes the primary symptoms presented, five prioritization categories and several descriptors. Consensus (>90%) was reached during the second expert consultation. Fifty-seven (91.9%) participants stated that the obstetric telephone triage guideline was clinically complete, correct, user-friendly and well designed, and 61 (98.4%) participants judged that the newly designed triage guideline was ready to use in daily practice.
Key-Conclusions and Implications for Practice
An evidence-based guideline for obstetric telephone triage was developed through a multi-phase multi-center study with all stakeholders. The guideline was found to be clinically complete, correct, well-designed and user-friendly. It provides a uniform and concrete basis for assessing the severity of the symptoms of obstetric emergency and other unplanned care requests originating by telephone. It also provides a good basis to further develop this evidence-based guideline for telephone triage by continuous registration of all calls.
Acknowledgments
The authors wish to thank all participating obstetric professionals of the following ten hospitals: OLVG Amsterdam, Leiden University Medical Center, Leiden, Amphia hospital Breda, Elisabeth Tweesteden hospital Tilburg, Jeroen Bosch hospital ‘s Hertogenbosch, Ziekenhuisgroep Twente (ZGT) Almelo- Hengelo, Tjongerschans hospital Heerenveen, Erasmus Medical Center Rotterdam, Albert Schweitzer hospital Dordrecht and Amstelland hospital Amstelveen. The authors also wish to thank Ageeth N. Rosman (PhD), Doug J. Cronie (PhD), Nicole Y.C. Steemers (MD), Lisette van Hulst for feedback and editing assistance.
Clinical Trial Registry
Not applicable.
Abbreviations
ESI, Emergency Severity Index; MFTI, Maternal Fetal Triage Index; MTS, Manchester Triage System; NTS, Dutch Triage Standard; OTAS, Obstetric Triage Acuity Scale; ROTS, Rotterdam Obstetric Triage System; SETS, Swiss Emergency Triage Scale.
Ethical Approval and Consent
The study was approved by the Medical Research Ethics Committees United (MEC-U) and the Medical Ethics Committee of Leiden University Medical Center (LUMC, 2016) Act (W.16.053 and P17.075/PG/pg). The study was submitted to and approved in 2016 by the daily Boards MEC-U and the Medical Ethics Committee of Leiden University Medical Center (LUMC, 2016). As a result of these reviews, the boards declared that the rules laid down in the Medical Research Involving Human Subjects Act (also known by its Dutch abbreviation WMO) do not apply to the study. No additional approval was requested for the current study since it is not based upon a clinical study or patient data. All participants gave digital-informed consent to use the data for analyses. All data were anonymously processed. Participants were able to resign at any time, without any statement of reasons.
Author Contributions
All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation. And took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.
Disclosure
The authors declare that they have no competing interests.