EFFICACY OF AN OBSTETRICAL TRIAGE SYSTEM IN LMICs Evaluation of the ability of a standardized obstetric emergency triage assessment and treatment (ETAT) system to improve documentation of triage assessment — a proxy measure for triage quality — at Cape Coast Teaching Hospital (CCTH) obstetrical unit. TOTAL 372 PRE 118 PREGNANT INTERIM 121 POST 133 POSTPARTUM TOTAL 24 PRE 8 INTERIM 8 POST 8 396 1 2 3 4 Results support efficacy of ETAT at CCTH In pregnancy group, training effective for all 10 History elements Increased consistency of documentation of Vitals and Plan over time Greatest improvement after ETAT first implementation 1. Benefit from regular, earlier retraining 2. Drop-off because of higher baseline of triage practices after initial training? DISCUSSION METHODOLOGY pregnancy group 0 20 40 60 80 100 120 NO YES COUNTS REASON FOR REFERRAL 0 20 40 60 80 100 120 NO YES COUNTS GRAVIDITY/ PARITY 0 20 40 60 80 100 120 NO YES COUNTS GESTATIONAL AGE 0 10 20 30 40 50 60 70 80 90 100 NO YES COUNTS CONTRACTION PATTERN 0 20 40 60 80 100 120 NO YES COUNTS CERVICAL DILATATION 0 10 20 30 40 50 60 70 80 90 NO YES COUNTS VAGINAL FLUID LOSS 0 20 40 60 80 100 120 NO YES COUNTS FETAL HEART RATE 0 20 40 60 80 100 120 NO YES COUNTS FETAL MOVEMENT 0 20 40 60 80 100 120 NO YES COUNTS VITAL SIGNS 0 20 40 60 80 100 120 NO YES COUNTS PLAN FOR CARE 0 1 2 3 4 5 6 7 8 9 NO YES COUNTS GRAVIDITY/PARITY 0 1 2 3 4 5 6 7 8 9 10 NO YES COUNTS GESTATIONAL AGE 0 1 2 3 4 5 6 7 8 9 10 NO YES COUNTS PLAN FOR CARE 0 1 2 3 4 5 6 7 8 9 10 NO YES COUNTS VAGINAL FLUID LOSS 0 1 2 3 4 5 6 7 8 9 10 NO YES COUNTS VITAL SIGNS Study of women presenting to CCTH obstetrical unit. Data collected via chart reviews of consecutive women presenting at three discrete intervals: Prior to ETAT training (PRE), April – June 2016 After initial ETAT training (INTERIM) October – December 2017 After ETAT re-training (POST) November 2018 – January 2019 postpartum group one ¯ way anova Comparison of documentation rate of all history elements Increased between the PRE and INTERIM periods (p<0.001) Decreased between the INTERIM and POST periods (p=0.047) No significant difference between the PRE and POST period (p=0.349) The mean number of elements documented 2 3 4 5 Pre Interim Post 5.0 5.5 6.0 6.5 7.0 Pre Interim Post Legend PRE INTERIM POST Dr. Lauren Adolph MD, Dr. Richard Pinkrah MD, Dr. David Walawah MD, Dr. Evans Agbeno MD, FWACS, Dr. Betty Anane-Fenin MD, FWACS, Ms. Amewadzi, Ms. Ofori, Janet Slaunwhite, Ms. Merso, Dr. Ronald B. George MD, FRCPC, Dr. Heather Scott MD, FRCSC Documentation Rate (Mean) Pregnancy Group Postpartum Group Documentation Rate (Mean) Documentation rates of 10 key history elements were obtained Mean (95% CI)