Implementing Maternal Fetal Triage Index (MFTI) in a High-Risk Obstetrical Setting

Problem: The Maternal Fetal Triage Index (MFTI) for obstetric triage provides a systematic method for assessing and assigning acuity. Data evaluated for February 2024 and March 2024 identified the need for improved response times for triage Priority Two, which averaged 28.75 minutes (goal 15 minutes) for a provider to present to the bedside. The average percentage of patients with documented MFTI scores was 70.65% ( goal >80%). Context: A high-risk 24-bed obstetrical department in an acute care hospital in Northern California that triages over 600 patients monthly with over 400 deliveries in the same period. Interventions: Real-time observations and staff feedback were provided using Kamishibai (K) cards. A cause and reaction statement was collected, documented, and discussed for identified unmet objectives. A Pareto chart was used to analyze missing elements and inform additional PDSA cycles to improve the percentage of MFTI completion. Measures: The primary outcome measure was the time between provider notification and arrival at the bedside for MFTI Priority Two. Process measures included an increase in patients assigned an MFTI score. Results: Provider time to triage for MFTI Priority Two increased slightly from 28.75 minutes to 28.8 minutes, and the percentage of patients assigned an MFTI score improved slightly from 70.65% to 73%. Conclusions: MFTI provides a standardized and objective priority-driven process capable of improving triage efficiency and maternal-fetal outcomes; however, experienced clinical staff chose to rely on their clinical judgment, limiting the adoption of the MFTI scoring tool. Keywords: Maternal-Fetal Triage Index, MFTI, OB triage, Kamishibai cards, K cards