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

Sebastian J. Geraci; Kevin Espino; Rosanne Vertichio; Meredith Akerman; Filomena Greco; Anju Suhag; Patricia Rekawek; Karyn Wat

doi:10.1055/a-2562-1735

American Journal of Perinatology, Table of Contents

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

Authors

Sebastian J. Geraci

¹Department of Obstetrics and Gynecology, NYU Langone Hospital-Long Island, NYU Grossman Long Island School of Medicine, Mineola, New York
Kevin Espino

¹Department of Obstetrics and Gynecology, NYU Langone Hospital-Long Island, NYU Grossman Long Island School of Medicine, Mineola, New York
Rosanne Vertichio

¹Department of Obstetrics and Gynecology, NYU Langone Hospital-Long Island, NYU Grossman Long Island School of Medicine, Mineola, New York
Meredith Akerman

²Department of Biostatistics, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York
Filomena Greco

¹Department of Obstetrics and Gynecology, NYU Langone Hospital-Long Island, NYU Grossman Long Island School of Medicine, Mineola, New York
Anju Suhag

¹Department of Obstetrics and Gynecology, NYU Langone Hospital-Long Island, NYU Grossman Long Island School of Medicine, Mineola, New York
Patricia Rekawek

¹Department of Obstetrics and Gynecology, NYU Langone Hospital-Long Island, NYU Grossman Long Island School of Medicine, Mineola, New York
Karyn Wat

¹Department of Obstetrics and Gynecology, NYU Langone Hospital-Long Island, NYU Grossman Long Island School of Medicine, Mineola, New York

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

Full Text

References

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