Observational study of the third delay in emergency obstetric triage at the referral national hospital in Tanzania: Baseline survey.

Abstract

Aim: This study aimed to grasp the third delay using an observational method of actual nurses/midwives' practice overtime during care provision to emergency obstetric patients in a tertiary referral national hospital.

Methods: A prospective quantitative design was employed to observe the 24-h obstetric triage process from February 4 to March 7, 2023.

Results: This study involved observations of 120 obstetric patients with mean maternal age of 29.1 years (SD = 5.5); 81.6% were between 20 and 35 years, 14.2% were over 35 years, and 4.2% were under 20 years. There were 99 (82.5%) pregnant women: 67.7% were preterm, 29.3% term, and 3% postdate, and there were 21 (17.5%) postpartum women. Initial diagnoses were postpartum hemorrhage, 9 (7.5%), antepartum hemorrhage, 15 (12.5%), eclampsia, 13 (10.8), severe preeclampsia, 19 (15.9), preeclampsia, 12 (10%), obstructed labor, 3 (2.5%), previous scar, 13 (10.8%), and others, 36 (30%). Waiting time was within 15 minutes for 30.8% of the observations. Median waiting time from registration to consultation was 9 min. Interquartile range (IQR) for postpartum hemorrhage was 3.5-23.5 min, and IQR for eclampsia was 11.5-117.5. There were no maternal deaths during the 24-h observation of each obstetric patient.

Conclusion: The obstetric triage process requires additional training for triaging time-sensitive obstetric complications; the wide IQR of waiting time indicated management misalignments thus causing the third delay. The clinical priority of obstetric patients with leading risk factors for morbidity and mortality, such as hypertensive disorders of pregnancy and hemorrhage, needs to be approached within a continuum of care.