A Multidisciplinary Approach to Peripartum Triaging of Patients to the Operating Room

Objective: At our institution, a triage or leveling system for emergency surgeries in the general operating rooms (OR) exists with the goal of optimizing patient care and reducing morbidity and mortality. In the obstetric field, medical terminology exists for these situations to delineate and convey the urgency of a particular peripartum situation such as “stat, emergent, or urgent”; however, this terminology is not universal and somewhat ambiguous, causing confusion and unnecessary delays in patient care. In this concept paper, we proposed a quality improvement project that delineates terminology for obstetrical triaging to the operating room (OR) and discussed metrics for evaluation of this quality intervention. Methods: We developed a four-level stratification system to triage patients using clear guidelines for all OR cases. Our system accounted for maternal and fetal stability, indication for surgical intervention, role for obtaining additional studies, nil per os (NPO) status, and surgical and anesthetic concerns. Within each classification, we defined the expectations for each team member's role, including the obstetrician, anesthesiologist, charge nurse, nursing staff, neonatal intensive care unit (NICU) team, and the surgical and clinical technicians. Results: Several metrics will be collected to evaluate this multidisciplinary quality improvement initiative, including maternal demographics, labor characteristics, and indication for surgery. Additional data includes level assigned, time to OR, type of surgery performed and anesthetic delivered. We will collect fetal delivery data (Apgar scores and umbilical cord gases), as well as maternal delivery data, including estimated blood loss, time to uterine incision and delivery, and surgical complications. Conclusions: We propose a multidisciplinary four-category triaging system to delineate the communication and action plan for obstetrical OR cases. We omitted ambiguous terms and developed an algorithm for patients according to acuity and risk. Our quality improvement intervention allows for rapidly changing circumstances and accounts for both obstetric and anesthetic considerations.