Task shifting: a key aspect to improving care for women at risk of preterm birth.

Abstract

Local problem: Until April 2021, women presenting to maternity triage with symptoms of threatened preterm labour (TPTL) and/or preterm premature rupture of the membranes (PPROM) were triaged by a doctor. Depending on the acuity on the labour ward, women in triage often had a long wait for a doctor's review. These delays create anxiety for women and impair the capacity of triage midwives to care for other women.

Methods: The Plan-Do-Study-Act method of quality improvement was used for this project. 3 months prior to the intervention, the baseline assessment was women's wait time for medical review when presenting with TPTL and/or PPROM.

Intervention: Triage midwives were trained in performing speculum examination on preterm (<37 weeks' gestation) women to allow quicker review. Waiting time for review by a midwife vs doctor was compared using data collected between January and December 2021.

Results: 88 eligible women were identified. 44 cases (intervention group) had their initial assessment by the triage midwife, while 44 cases (control group) had their initial assessment by a doctor. The mean waiting time between arrival and performance of quantitative fetal fibronectin (qfFN) in the intervention group was 67 min (SD=42.7), compared with 127 min (SD=61.2) in the control group (p<0.001). However, there was no significant difference in the waiting time between arrival and discharge/admission.

Conclusion: Women presenting with symptoms of TPTL are reviewed on average twice as quickly by the triage midwife compared with a doctor, allowing a quick reassurance for those where TPTL/PPROM has been excluded. However, the overall waiting time in triage was similar, as women in our unit currently need a doctor's review before discharge.