The Maternal Fetal Triage Index (MFTI) tool developed by obstetric experts at AWHONN is a recent advance that deserves attention from all obstetric professionals. If you haven’t yet learned of it, stay tuned, because you will be hearing much about it as it goes “live” in the EMR of many institutions around the country.
As everyone is aware, standardization has proven to be linked to risk reduction and proven safety. Reduction of variation of the perinatal triage process is no different. As perinatal patients continue to present to obstetric units with increased acuity, complexity and volume, the perinatal triage nurse is at the forefront of initial decision-making about patient entry into the system. Standardization of process and appropriate designation of patient prioritization is the cornerstone of safety, as timely responsiveness is critical. Failure to recognize and respond to change of patient condition, failure-to-rescue incidents, and lack of timely triage are all increasingly litigated areas of obstetrics. The MFTI addresses key patient safety issues in a systematic approach, working to prevent untimely maternal-fetal death.
AWHONN has invested much time in improving the process of perinatal triage. The MFTI specifically addresses both maternal and fetal evaluation immediately at the time of patient presentation and improves efficiency of workflow. The tool is easy to use, and AWHONN provides the necessary education for implementation. Quality of care is improved by the fact that patient prioritization for provider evaluation is enhanced, escalation of care level occurs in a timely manner, and outcome is ultimately improved for both mother and baby.
The MFTI is a one-page algorithm that organizes perinatal triage assessment and prioritization. The tool is modeled after the Emergency Severity Index (ESI) that is very familiar to ED staff nationwide. ED staff evaluate the acuity level and then progress with disposition and level of care. The ESI tool is known to improve outcomes by improving response time for the highest acuity patients. The MFTI is similar to the ESI, with the exception that it is perinatal/obstetric-specific and it pertains to all gestational ages (ESI only addresses some gestational ages). Attention is directed to the highest acuity patients as determined by the perinatal nurse at the time the patient presents. While the MFTI does cover the entire duration of gestation and pregnancy, it focuses on the presenting symptoms and required urgency.
The MFTI has 5 levels of acuity. Each level provides a decision-making point that leads to designation of an appropriate care level. The goal is to reduce the time frame that elapses between presentation and actual care. The levels are purposefully orchestrated for patient prioritization with rational for each level selected.
- Level I: Stat -- Immediate attention; life-saving for mom and baby
- Level 2: Urgent -- Severe pain not related to labor; high-risk condition; possible transfer
- Level 3: Prompt -- ≥ 34 weeks in active labor or not coping with labor
- Level 4: Non-Urgent -- ≥ 37 weeks with signs and symptoms of early labor or common pregnancy discomfort
- Level 5: Scheduled -- Requested services or scheduled procedures
(Abnormal vital signs are linked with levels 1 to 3.)
The MFTI tool has had expert obstetric multidisciplinary panel review for both development and validation. It has withstood the rigors of content validity testing and is ACOG endorsed as of July 2016 (Committee Opinion Bulletin #667). Those that have implemented the tool report increased patient satisfaction, decreased patient wait times, and a reduction in triage safety-related events. Implementation adaptation goals include consistency and efficiency of process, improved efficiency of prioritization, and improved communication between the obstetric team members. Retrospective data analysis can help hospitals view trends of acuity and staffing needs as well as swiftness of response to emergency situations.
Implementation of change of practice requires a shared vision for quality improvement. With change comes challenge, and challenges will be inevitable. Ongoing evaluation certainly will be necessary, but with so many positives presented with MFTI use, I encourage all of you to engage your hospital obstetric leaders to review this tool and encourage its use. The MFTI should be viewed as an updated approach to perinatal triage and safety. Successful implementation of the MFTI can only improve standardization, risk reduction, teamwork collaboration and communication.
For further information about MFTI tool, contact AWHONN directly or go to the MFTI section on AWHONN’s web site.
JOGNN, Nov/Dec 2015, pp 693-710 offers three articles specific to MFTI:
- Evans, M., Watts, N., and Grafton, R. Women’s Satisfaction with OB Triage services.
- Ruhl, C. Scheich, B. et al. Content Validity Testing of the MFTI.
- Ruhl, C. Scheich, B. et al. Interrater Reliability Testing of the MFTI.