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Impact of Implementation of Maternal Fetal Triage Index on Patients Presenting with Decreased Fetal Movement

2021; Elsevier BV; Volume: 226; Issue: 1 Linguagem: Inglês

10.1016/j.ajog.2021.11.188

1097-6868

Eva Hoffmann, Shena J. Dillon, Amarily Barahona, Donald D. McIntire, David B. Nelson,

Neonatal Respiratory Health Research

Decreased fetal movement (FM) is a common reason for patient presentation to triage and may be the first sign of fetal jeopardy. We hypothesized that implementation of Maternal Fetal Triage Index (MFTI) would expedite timeliness of care. Our aim was to determine the impact of MFTI on time to admission, induction, and vaginal delivery in women presenting with decreased FM. This was a prospective, observational study of pregnant women presenting with decreased FM at a large urban, inner-city academic facility before and after implementation of MFTI. Triage is staffed by advanced practice providers (APPs) utilizing standardized protocols for assessment and admission criteria. The MFTI tool was implemented on 3/1/2021 following standardized education in 2020 for all nurses, techs, healthcare unit coordinators and APPs. Clinical outcomes of time to admission, induction, and vaginal delivery in cases of decreased FM at term were examined prior to MFTI (epoch 1: 1/1/2019-12/31/2019) to afterward (epoch 2: 3/1/21-5/31/2021) Statistical analysis used Wilcoxon rank sum with p< 0.05 considered significant. 513 women were admitted for decreased FM in epoch 1 and 258 in epoch 2. Demographic features were similar between the epochs (Table). Across all measures, clinical performance improved with time from admission to assessment (P=0.001), start of induction (P=0.018), and vaginal delivery (P=0.035) becoming significantly faster in epoch 2 after implementation of MFTI (Figure). After implementation of the MFTI at a high-volume inner-city hospital triage with APPs, there were significantly faster time intervals from arrival to assessment, start of induction, and vaginal delivery. This suggests MFTI is a mechanism that can improve efficiency both within triage and also labor and delivery to optimize resources.View Large Image Figure ViewerDownload Hi-res image Download (PPT)