AHRQ’s Emergency Severity Index Used to Inform Development of Obstetric Triage Tool

Patient Safety
July 2015

The Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) used AHRQ’s Emergency Severity Index (ESI) to inform development of a tool used to triage obstetric patients. The ESI classifies patients into five categories according to the severity of their conditions and the resources needed for treatment.

Debra Bingham, Dr.P.H., R.N., vice president of nursing research, education, and practice for AWHONN, said the nursing community lacked a nationally accepted obstetric triage tool until AWONN developed its tool. The organization used AHRQ’s ESI as one of its research-based resources.

AWHONN’s tool, the Maternal Fetal Triage Index (MFTI), was developed to:

  • Help health professionals communicate better in obstetric settings.
  • Improve patient tracking.
  • Promote a systematic method for prioritizing the evaluation and treatment of pregnant women.

"A more detailed tool was needed to describe the levels of urgency of the conditions women and their fetuses present with during all pregnancy trimesters,” Dr. Bingham said. “Information was also needed about how to better track the common reasons women seek care after 20 weeks of gestation, which include preterm and term labor and hypertensive conditions."

In 2012, an AWHONN task force assigned to develop a triage tool consulted researchers with knowledge about AHRQ’s ESI. The ESI’s triage levels range from Level 1—which includes patients who are unresponsive, not breathing, or intubated—to Level 5—which includes patients who are predicted to require a minimal level of assessment and services.

As triaging pregnant women is a common occurrence, “a valid and reliable tool was needed to ensure each woman and fetus receives the appropriate care at the appropriate time and at the appropriate location,” noted Catherine Ruhl, M.S., C.N.M., director of women’s health programs at AWHONN.

Informed by the ESI’s standardized approach, the task force created a five-level triage index with 61 items and key questions for clinical conditions in each level. In 2013, the index completed its content validity testing with 45 registered nurses, physicians, and certified nurse midwives.

“Data gathered on patients with this tool can help plan effective and efficient nurse staffing, set benchmarks for care, enable public health surveillance, and monitor institutional trends over time. The data can also be used for research,” said Benjamin Scheich, M.S., director of data analytics.

“The MFTI tools and an educational module are scheduled for release to nurses and other health care providers in 2015,” noted Brea Onokpise, M.P.H., project manager.

Impact Case Study Identifier: 
AHRQ Product(s): Emergency Severity Index
Topics(s): Women, Children/Adolescents, Emergency Medical Services (EMS), Emergency Severity Index
Geographic Location: National
Implementer: Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN)
Date: 07/16/2015
Page last reviewed July 2015
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