Impact of implementation of the Maternal-Fetal Triage Index on patients presenting with severe hypertension

• Published in: American journal of obstetrics and gynecology 2022-09, Vol.227 (3), p.521.e1-521.e8
• Main Authors: Hoffmann, Eva, Wilburn-Wren, Kristie, Dillon, Shena J., Barahona, Amarily, McIntire, Donald D., Nelson, David B.
• Format: Article
• Language: English
• Subjects: abruption; antihypertensives; blood pressure; hydralazine; labetalol; labor and delivery; magnesium sulfate; metrics; nursing; preeclampsia
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/j.ajog.2022.06.006

Severe hypertension remains one of the leading preventable causes of maternal mortality in the United States. Timeliness to response to severe hypertension in pregnancy is a crucial quality indicator tracked by state and national organizations. We hypothesized that the implementation of the Maternal-Fetal Triage Index, a validated acuity tool, would improve care performance in women with severe hypertension in an urban, inner-city hospital setting. This study aimed to assess the impact of the Maternal-Fetal Triage Index on the management of women presenting with severe preeclampsia diagnosed by severe hypertension as measured by time to provider assessment, administration of magnesium sulfate, and immediate administration of acute antihypertensives. This was a prospective, observational study of pregnant women presenting to the labor and delivery triage unit with severe preeclampsia diagnosed by severe hypertension giving birth at a large urban inner-city academic facility before (epoch 1: January 1, 2019, to December 31, 2019) and after (epoch 2: March 1, 2021, to September 31, 2021) the implementation of the Maternal-Fetal Triage Index. Baseline outcomes of time to assessment, time to magnesium sulfate prophylaxis, and time to antihypertensive medication administration before the implementation of the Maternal-Fetal Triage Index were assessed. The Maternal-Fetal Triage Index tool was implemented on March 1, 2021, following standardized education in 2020 for all triage nurses, unit technicians, healthcare unit coordinators, and healthcare providers. Time to assessment, administration of magnesium sulfate prophylaxis, and time to antihypertensive administration after the implementation of the Maternal-Fetal Triage Index were compared with measures before the implementation of the Maternal-Fetal Triage Index. Statistical analysis included Wilcoxon rank-sum test with P