The Labour Assessment Unit on the fourth floor of Royal University Hospital in Saskatoon is where women greater than 16 weeks pregnant come if they are having pregnancy complications or if they are in labour. Ensuring expectant mothers move quickly through this triaging process was the focus of a recent improvement event in Saskatoon Health Region.

RR-2016-02-10-RPIW-140-maternal-1Prior to this improvement event, women would present to a registration clerk on the unit and proceed to the nursing desk. At this time, a unit assistant or RN would take them to a room for assessment.

“There was no standardized way to determine how urgent the patient’s condition was and then how quickly they should been seen by a physician,” said Leanne Smith, director of maternal services for Saskatoon Health Region, a co-lead of the improvement team.

So the team implemented the Obstetrical Triage Acuity Scale (OTAS) which objectively categorizes the patient into OTAS groups that have recommended times for both nursing and physician responses. Category 1 is the most urgent, requiring immediate response; Category 5 is the least urgent, where the patient should be seen by a physician within two hours.

“With OTAS it is important that a patient is first seen by a health care practitioner so that their acuity can be assessed,” Smith explained, “and in the current process, the first person to see the patient was a registration clerk. The team had to look at how we could ensure a patient was assessed by a nurse first.”

Their solution was to locate both the registration clerk and the triage nurse in the same area, which leads to quicker identification of at-risk moms. Because of the crowding this might create, the team came up with the idea to register scheduled appointments through the waiting room window instead of the registration desk.

The team clarified roles of the triage and assessment nurses, identified an alcove for fast-tracking Category 1 patients, and created a fast-tracking process. The team also improved and organized the waiting room.

In the end, the team was able to design a process that ensures expectant mothers see a physician appropriately, and was less confusing to patients.

Prior to the team starting its work, patients reported that when they walked in, they felt confused, frustrated by the registration process, and worried while they were triaged.

With the improvements in place, patients surveyed reported being happy with the entire process.

“We were really happy to hear that,” noted Smith. “The whole point of making these improvements was to make things safer and easier for our expectant moms, especially those coming in with a concern about their health or pregnancy.”