Download PDF
Am J Perinatol
DOI: 10.1055/a-2562-1735
Original Article

Factors Influencing Time to Disposition in Obstetric Triage: A Clinical, Operational, and Patient-Specific Analysis

Sebastian J. Geraci 
1   Department of Obstetrics and Gynecology, NYU Langone Hospital-Long Island, NYU Grossman Long Island School of Medicine, Mineola, New York
,
Kevin Espino
1   Department of Obstetrics and Gynecology, NYU Langone Hospital-Long Island, NYU Grossman Long Island School of Medicine, Mineola, New York
,
Rosanne Vertichio
1   Department of Obstetrics and Gynecology, NYU Langone Hospital-Long Island, NYU Grossman Long Island School of Medicine, Mineola, New York
,
Meredith Akerman
2   Department of Biostatistics, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York
,
Filomena Greco
1   Department of Obstetrics and Gynecology, NYU Langone Hospital-Long Island, NYU Grossman Long Island School of Medicine, Mineola, New York
,
Anju Suhag
1   Department of Obstetrics and Gynecology, NYU Langone Hospital-Long Island, NYU Grossman Long Island School of Medicine, Mineola, New York
,
Patricia Rekawek
1   Department of Obstetrics and Gynecology, NYU Langone Hospital-Long Island, NYU Grossman Long Island School of Medicine, Mineola, New York
,
Karyn Wat
1   Department of Obstetrics and Gynecology, NYU Langone Hospital-Long Island, NYU Grossman Long Island School of Medicine, Mineola, New York
› Author Affiliations Funding None.
› Further Information
Also available at
    Permissions and Reprints

Abstract

Objective

This study aimed to assess factors impacting obstetric triage time to disposition. The primary and secondary hypotheses were that high-risk patients and patients evaluated during periods with less staffing would experience prolonged length of stay (LOS), respectively.

Study Design

This single-site, retrospective cohort study analyzed 9,704 obstetric triage visits of 6,182 patients between January 1, 2022, to February 28, 2023. Inclusion criteria included patients 18 years or older with one or more evaluations. Exclusion criteria included scheduled admissions, unknown chief complaints, triage time under 10 minutes, and patients under 18 years old. A total of 6,612 visits representing 4,390 patients were included. The visits were stratified by disposition: admission versus nonadmission (transfer or discharge). Descriptive statistics analyze continuous variables. Frequencies and percentages were calculated for categorical variables. SAS was used for chi-square or Fisher's exact test for categorical variables and the two-sample t-test or Mann–Whitney test for continuous data. Statistical significance was p-value < 0.05.

Results

Of 6,612 visits, 3,475 admissions, and 3,137 nonadmissions occurred. The most common chief complaints were contractions (42%), amniotic fluid index evaluation (18%), and preeclampsia evaluation (8%). Admitted compared with nonadmitted patients had shorter LOS (64 minutes vs. 185 minutes, p < 0.001). Admitted compared with nonadmitted patients had shorter LOS by chief complaint, gestational age, high-risk maternal–fetal medicine status, time of day, and day of the week (all p < 0.001).

Conclusion

Nonadmitted, maternal–fetal medicine and preterm patients evaluated during daytime and weekdays had significantly longer LOS. Vulnerable populations and target times for triage workflow improvement were identified.

Key Points

  • Patient and unit factors influenced LOS.

  • Nonadmitted patients had triple the LOS.

  • High-risk patients had longer LOS.

  • Daytime and weekday visits had longer LOS.

Keywords

emergency care - labor and delivery - length of stay - obstetric triage - triage disposition


Publication History

Received: 19 February 2025

Accepted: 18 March 2025

Article published online:
16 April 2025

© 2025. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Rashidi Fakari F, Simbar M, Zadeh Modares S, Alavi Majd H. Obstetric triage scales; a narrative review. Arch Acad Emerg Med 2019; 7 (01) e13
    PubMedSearch in Google Scholar
  • 2 Smithson DS, Twohey R, Watts N, Gratton RJ. The impact of standardized acuity assessment and a fast-track on length of stay in obstetric triage: a quality improvement study. J Perinat Neonatal Nurs 2016; 34 (04) 310-318
    CrossrefPubMedSearch in Google Scholar
  • 3 Ruhl C, Garpiel SJ, Priddy P, Bozeman LL. Obstetric and fetal triage. Semin Perinatol 2020; 44 (04) 151240
    PubMedSearch in Google Scholar
  • 4 Kodama S, Mokhtari NB, Iqbal SN, Kawakita T. Evaluation of the maternal-fetal triage index in a tertiary care labor and delivery unit. Am J Obstet Gynecol MFM 2021; 3 (04) 100351
    PubMedSearch in Google Scholar
  • 5 Committee Opinion No. Committee opinion no. 667: hospital-based triage of obstetric patients. Obstet Gynecol 2016; 128 (01) e16-e19
    CrossrefPubMedSearch in Google Scholar
  • 6 Zocco J, Williams MJ, Longobucco DB, Bernstein B. A systems analysis of obstetric triage. J Perinat Neonatal Nurs 2007; 21 (04) 315-322
    PubMedSearch in Google Scholar
  • 7 Hoffmann E, Wilburn-Wren K, Dillon SJ, Barahona A, McIntire DD, Nelson DB. Impact of implementation of the maternal-fetal triage index on patients presenting with severe hypertension. Am J Obstet Gynecol 2022; 227 (03) 521.e1-521.e8
    PubMedSearch in Google Scholar
  • 8 Lindroos L, Korsoski R, Öhman MO, Elden H, Karlsson O, Sengpiel V. Improving assessment of acute obstetric patients - introducing a Swedish obstetric triage system. BMC Health Serv Res 2021; 21 (01) 1207
    PubMedSearch in Google Scholar
  • 9 Foley M, Kifaieh N, Mallon WK. Financial impact of emergency department crowding. West J Emerg Med 2011; 12 (02) 192-197
    PubMedSearch in Google Scholar
  • 10 Falvo T, Grove L, Stachura R. et al. The opportunity loss of boarding admitted patients in the emergency department. Acad Emerg Med 2007; 14 (04) 332-337
    PubMedSearch in Google Scholar
  • 11 Moudi A, Iravani M, Najafian M, Zareiyan A, Forouzan A, Mirghafourvand M. Exploring the concept and structure of obstetric triage: a qualitative content analysis. BMC Emerg Med 2020; 20 (01) 74
    PubMedSearch in Google Scholar
  • 12 Angelini D, Howard E. Obstetric triage: a systematic review of the past fifteen years: 1998-2013. MCN Am J Matern Child Nurs 2014; 39 (05) 284-297 , quiz 298–299
    PubMedSearch in Google Scholar
  • 13 Association of Women's Health, Obstetric and Neonatal Nurses. Standards for professional registered nurse staffing for perinatal units. J Obstet Gynecol Neonatal Nurs 2022; 51 (04) e5-e98
    PubMedSearch in Google Scholar