Obstetric triage: a systematic review of the past fifteen years: 1998-2013.

BACKGROUND: Triage concepts have shifted the focus of obstetric care to include obstetric triage units. The purpose of this systematic review is to examine the literature on use of triage concepts in obstetrics during a 15-year time frame. METHODS: A systematic review was completed of the obstetric triage literature from 1998 to 2013 using the electronic online databases from PubMed, CINHAL, Ovid, and Cochrane Library Reviews within the English language. Reference lists of articles were reviewed to identify other pertinent publications. Both peer-reviewed and non-peer-reviewed documents were used. INCLUSION CRITERIA: articles specifically related to obstetric triage or obstetric emergency practices in the hospital setting. Exclusion criteria included: manuscripts that focused on general, nonobstetric emergency and triage units, telephone triage, out-of-hospital practices, other clinical conditions, and references outside the time frame of 1998-2013. RESULTS: Key categories were identified: legal issues and impact of Emergency Medical Treatment and Active Labor Act (EMTALA); liability pitfalls; risk stratification (acuity tools); clinical decision aids; utilization, patient flow, and patient satisfaction; impact on interprofessional education and advanced nursing practice; and management of selected clinical conditions. Components of a best practice model for obstetric triage are introduced. CONCLUSION: Seven key triage categories from the literature were identified and best practices were developed for obstetric triage units from this systematic review. Both can be used to guide future practice and research within obstetric triage.

Midwifery and obstetrics: twenty years of collaborative academic practice.

This review describes a collaborative educational practice model partnering midwifery and obstetrics within a department of obstetrics and gynecology. For more than 20 years, the authors' model has demonstrated sustainability and influence on medical education. The focus is on resident education in obstetrics, using midwifery faculty as teachers in the obstetric and obstetric triage settings. This noncompetitive and integrated educational practice model has achieved sustainability and success using midwives in a collaborative approach to medical education. The continuing collaboration and innovation within medical and resident education are important elements for the future of collaborative practice.

Interdisciplinary and interprofessional education: what are the key issues and considerations for the future?

The identification of key issues and considerations for interdisciplinary and interprofessional education are explored. Both benefits and barriers to interprofessional education are discussed. The concept of simulation is reviewed relative to interprofessional education primarily as a catalyst for implementation of collaboration. The promise of interprofessional education and outcome studies direct where the future is headed.

A national survey of the midwifery director role in academic midwifery practices involved in medical education in the United States.

A survey to explore the role characteristics and key responsibilities of midwifery directors in academic practices involved in medical education in the United States was undertaken. Six key content areas were investigated: role responsibilities and characteristics, interaction with other medical divisions and committees, budgetary structure, interaction with learners, clinical schedules, and job satisfaction. A mail-based descriptive survey was distributed to 112 midwifery directors with a 56% response rate (N = 63). The results show a composite profile of academic midwifery practice directors involved in medical education that work primarily for departments of obstetrics and gynecology, are championed by the departmental chairperson, and have budgetary placement under this department. Collaboration with the residency director has not been fully realized, thereby limiting midwifery exposure and input regarding medical education, curricula changes, and access to key education committees. National changes in resident work hours had both a positive and negative impact on the director and overall midwifery practices. Job satisfaction documents both positive and challenging aspects to the director position, and most directors felt successfully integrated with physician colleagues.

Obstetric triage: models and trends in resident education by midwives.

Four models of resident education in obstetric triage with midwifery faculty consultants are presented. Common trends in the structure and function of these models are reviewed. The four models represent diverse settings where midwives serve as clinical teachers primarily for first-year obstetric residents and residents from other subspecialties. Each model supports a growing number of midwives working in the triage setting, functioning as both teacher and consultant for new residents. This expanded midwifery teaching role extends beyond labor assessment to include a wide range of common obstetric and gynecologic conditions in the triage setting. Additional advantages include the ability of the midwife to bill for triage services and to provide a safety net to decrease medical errors which, in a busy triage unit, occur most often during patient transfers.