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St. Joseph's Health Centre Toronto

Obstetrical Triage Acuity Scale improves care in Family Birthing Centre

More than 3,300 babies are born every year in St. Joseph’s Family Birthing Centre (FBC). As a result, there are more than 6,000 visits to the unit every year, two-thirds of which are unscheduled.

This can pose a significant challenge when there are several women at different stages of their pregnancy needing different levels of care and requiring services at the same time. To help keep patients safe, improve experience and make sure those who need to be seen quickly by a nurse and a doctor can be, we’ve implemented a new triage process.

The Obstetrical Triage Acuity Scale (OTAS) was put in place in October in the FBC. Whereas patients were once assessed on a first-come-first-served basis, the triage process assigns each person an acuity score – ranging from one to five – based on a rapid initial assessment to determine if they can safely wait for care. Those who require immediate attention are moved into a bed and assessed more thoroughly by a nurse and seen by a physician.

“We’re excited to be able to put this process in place here because it’s been really successful in improving safety and consistency in other hospitals,” said Luisa Guerrera, patient care manager of the FBC.

“Our first goal is to keep our patients safe, including when they come in for urgent care – we need to make sure that we can easily identify who needs to be seen right away so that we can help them as quickly as possible.”

The OTAS process was developed at London Health Sciences Centre, modeled after the Canadian Triage and Acuity Scale (CTAS) system used in Emergency Departments all over the world to help direct patients based on their level of need. Since implementation, Emergency Department triage scales have helped standardize care, use resources more appropriately and improve patient safety.

Cristina Evans is a patient and family advisor who helped create the implementation plan for OTAS at St. Joseph’s, bringing her own experience with the FBC to the table. She supported everything from signage to explain wait times, to helping consider what scenarios people might be experiencing when they come in.

“My role in this was being the voice at the table saying, ‘Well what about if this is your first baby? Or if you arrive at the Emergency Department?’ and they would say, ‘OK, let’s think about that,’” she said. “Being part of this project gave me an appreciation for how much care, thought and consideration needs to go into developing this type of a process – from staffing, scheduling and facilities to patient care always being the biggest priority.”

Since launching earlier this year, the OTAS process has helped contribute to improved patient flow.

“It’s still new but it’s been very promising so far,” Guerrera said. “This is best practice in obstetric care, which is why we have it here – we’re always looking for ways we can improve to make sure we’re providing our patients with the safest, highest quality care.”

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