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Determining Who Needs Emergency Attention First

This document reflects emerging clinical and scientific advances as of the date issued and is subject to change. The information should not be construed as dictating an exclusive course of treatment or procedure to be followed. ABSTRACT: Emergency departments typically have structured triage guidelines for health care providers encountering the diverse cases that may present to their units. Such guidelines aid in determining which patients must be evaluated promptly and which may wait safely, and aid in determining anticipated use of resources.

Although labor and delivery units frequently serve as emergency units for pregnant women, the appropriate structure, location, timing, and timeliness for hospital-based triage evaluations of obstetric patients are not always clear. Hospital-based obstetric units are urged to collaborate with emergency departments and hospital ancillary services, as well as emergency response systems outside of the hospital, to establish guidelines for triage of pregnant women.

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Recently developed, validated obstetric triage acuity tools may improve quality and efficiency of care and guide resource use, and they could serve as a template for use in individual hospital obstetric units. This Committee Opinion focuses on hospital-based triage of obstetric patients and attempts to offer approaches and frameworks for triage that are applicable to any center providing obstetric care.

Determining Who Needs Emergency Attention First

The concept of triage comes from the military, where workers in field hospitals use systematic principles to evaluate and prioritize how quickly wounded soldiers are fully evaluated and treated. Triage in hospitals typically is associated with emergency departments that aim to categorize and prioritize patients who present for emergent or urgent care before detailed evaluation and management. Emergency departments typically have structured triage guidelines for health care providers encountering the diverse cases that may present to their units.

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In a study of one large center, up to one third of evaluated women did not give birth at that time and were sent home or to another unit at the completion of their evaluation and management 2. Pregnant women most commonly present for evaluation for labor at term. However, preterm labor, signs and symptoms of preeclampsia, decreased fetal movement, preterm premature rupture of membranes, vaginal bleeding, and acute abdominal pain also are reported frequently.

Acute and critical conditions, such as motor vehicle collision injury, large abruptio placentae, or seizure, are less common, but they demand immediate attention and management. Pregnant patients could present for care to any institution providing urgent or emergent care. However, obstetric patients are best served if local emergency services develop protocols whereby pregnant patients are taken to the most appropriate facility, which may be a designated obstetric care center, with pregnancy status, level of acuity, and distance travelled all being important factors 3.

Guidelines from local and national regulatory organizations eg, state Department of Public Health, the Joint Commission should be followed. The federal Emergency Medical Treatment and Labor Act EMTALA requires an initial medical screening examination to determine if a true medical emergency exists; in the case of a pregnant woman, this includes evaluation of the woman and the fetus.

Triage in Conservation | Frontiers Research Topic

The medical condition of a woman having contractions is not considered an emergency if there is adequate time for her safe transfer before delivery or if the transfer will not pose a threat to the health or safety of the woman or the fetus 4. In the situation of preterm labor or preterm premature rupture of membranes, transport of the woman in labor is recommended if time allows 4. Antenatal transfer is associated with improved neonatal outcomes compared with neonatal transfer.

Typical triage protocols involve an initial assessment and decision about the priority level for evaluation. In the case of the pregnant patient, this assessment may be conducted by a registered nurse, certified nurse— midwife or certified midwife, nurse practitioner, physician assistant, or physician as designated by hospital policy. Triage is followed by the complete evaluation of the woman and the fetus by a health care provider with skills and training appropriate to evaluate the issues identified during triage. These elements will vary based on the issue at hand, and a full review or listing is beyond the scope of this document.

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Although a separate triage area and standing orders may facilitate care for obstetric triage patients, having an available health care provider appears to best optimize patient flow and reduce length of stay 6. The use of certified nurse—midwives or certified midwives who provide obstetric emergency care triage services, for example, may improve efficiency, reduce length of stay, and improve screening and evaluation 7. For a given center, the obstetrics department, in conjunction with the other appropriate departments, should establish written guidelines defining the appropriate unit to evaluate obstetric patients based upon criteria such as gestational age and delivery status, symptoms, medical condition, and available medical staff.

For instance, some nonobstetric conditions eg, highly transmissible infectious diseases like influenza or varicella, critical traumas, and acute chest pain may be better treated in another area of the hospital, regardless of gestational age. Conversely, many postpartum conditions may be best addressed by labor and delivery staff. Disaster preparedness plans should include care of pregnant women 3. For all of these reasons, coordination and communication between obstetric and emergency departments, as well as hospital ancillary services, is critical 3. Emergency departments should consider early consultation with obstetric care providers when triaging and managing pregnant patients, especially for patients beyond the first and early second trimesters.

To be considered an appropriate location to evaluate and care for pregnant patients, a unit should have the ability to perform basic ultrasonography and fetal monitoring. In cases that involve a woman with a viable pregnancy who is evaluated outside of an obstetric unit, it may be necessary to bring these resources from the obstetric unit to the location of the patient. Triage algorithms for obstetric acuity to assess and assign priority to obstetric patients may be useful.

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Women should be cared for according to triage acuity rather than by time of arrival. The Emergency Severity Index was designed by the Agency for Healthcare Research and Quality to triage nonpregnant adults and has been adopted by many emergency departments 8. Several obstetric triage acuity tools have been developed based on this model. Several of these tools have been tested for content validity 10 and interrater reliability 11 , 12 and may be used to improve quality and efficiency of care and guide allocation of resources. Hospital obstetric units are encouraged to develop triage protocols based on local conditions but informed by evidence-based decision making.

Examples are trauma from motor vehicle accidents, falls, and intimate partner violence. The MFTI is designed to guide clinical decision-making but does not replace clinical judgment. Vital signs in the MFTI are suggested values. Values appropriate for the population and geographic region should be determined by each clinical team, taking into account variables such as altitude. Figure 1. Rhyming Dictionary: Words that rhyme with triage. What made you want to look up triage? Please tell us where you read or heard it including the quote, if possible. Test Your Knowledge - and learn some interesting things along the way.

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Getting a handle on some usage advice. Some parents can act like animals or machines.


Are you watching or missing something? You all would not have guessed some of these. Some imitative words are more surprising than others. How to use a word that literally drives some people nuts. The awkward case of 'his or her'. Test your knowledge of words related to the season of longer days and vacations.

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Test your visual vocabulary with our question challenge! Build a city of skyscrapers—one synonym at a time. Definition of triage. Other Words from triage triage transitive verb. Examples of triage in a Sentence Nurses do triage in the emergency room. Recent Examples on the Web The doctors who scrambled to rescue and triage survivors in look back in search of lessons. First Known Use of triage , in the meaning defined at sense 1a. History and Etymology for triage French, sorting, sifting, from trier to sort, from Old French — more at try entry 1.

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