title: Acuity Assessment in Obstetrical Triage.
abstract: OBJECTIVE
  A five-category Obstetrical Triage Acuity Scale (OTAS) was developed with a comprehensive set of obstetrical determinants. The purposes of this study were: (1) to compare the inter-rater reliability (IRR) in tertiary and community hospital settings and measure the intra-rater reliability (ITR) of OTAS; (2) to establish the validity of OTAS; and (3) to present the first revision of OTAS from the National Obstetrical Triage Working Group.
  
  
  METHODS
  To assess IRR, obstetrical triage nurses were randomly selected from London Health Sciences Centre (LHSC) (n = 8), Stratford General Hospital (n = 11), and Chatham General Hospital (n= 7) to assign acuity levels to clinical scenarios based on actual patient visits. At LHSC, a group of nurses were retested at nine months to measure ITR. To assess validity, OTAS acuity level was correlated with measures of resource utilization.
  
  
  RESULTS
  OTAS has significant and comparable IRR in a tertiary care hospital and in two community hospitals. Repeat assessment in a cohort of nurses demonstrated significant ITR. Acuity level correlated significantly with performance of routine and second order laboratory investigations, point of care ultrasound, nursing work load, and health care provider attendance. A National Obstetrical Triage Working Group was formed and guided the first revision. Four acuity modifiers were added based on hemodynamics, respiratory distress, cervical dilatation, and fetal well-being.
  
  
  CONCLUSIONS
  OTAS is the first obstetrical triage scale with established reliability and validity. OTAS enables standardized assessments of acuity within and across institutions. Further, it facilitates assessment of patient care and flow based on acuity.
authors.affiliation: Department of Obstetrics & Gynaecology, Schulich School of Medicine & Dentistry, University of Western Ontario, London ON; London Health Sciences Centre, London ON.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Gratton
authors.affiliation: Department of Obstetrics & Gynaecology, Schulich School of Medicine & Dentistry, University of Western Ontario, London ON.
authors.forename: Neila
authors.initials: N
authors.lastname: Bazaracai
authors.affiliation: Department of Obstetrics & Gynaecology, Schulich School of Medicine & Dentistry, University of Western Ontario, London ON.
authors.forename: Ian
authors.initials: I
authors.lastname: Cameron
authors.affiliation: Mount Sinai Hospital, Toronto ON.
authors.forename: Nancy
authors.initials: N
authors.lastname: Watts
authors.affiliation: Canadian Triage and Acuity Scale National Working Group, Interior Health Authority, Kelowna BC.
authors.forename: Colleen
authors.initials: C
authors.lastname: Brayman
authors.affiliation: Stratford General Hospital, Stratford ON.
authors.forename: Gregg
authors.initials: G
authors.lastname: Hancock
authors.affiliation: London Health Sciences Centre, London ON.
authors.forename: Rachel
authors.initials: R
authors.lastname: Twohey
authors.affiliation: London Health Sciences Centre, London ON.
authors.forename: Suhair
authors.initials: S
authors.lastname: AlShanteer
authors.affiliation: Department of Obstetrics & Gynaecology, Schulich School of Medicine & Dentistry, University of Western Ontario, London ON.
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Ryder
authors.affiliation: London Health Sciences Centre, London ON.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Wodrich
authors.affiliation: London Health Sciences Centre, London ON.
authors.forename: Emily
authors.initials: E
authors.lastname: Williams
authors.affiliation: McGill University Health Centre, Glen Site, Montreal QC.
authors.forename: Amélie
authors.initials: A
authors.lastname: Guay
authors.affiliation: BC Women's Hospital and Health Centre, Vancouver BC.
authors.forename: Melanie
authors.initials: M
authors.lastname: Basso
authors.affiliation: Division of Reproductive Medicine, Department of Obstetrics & Gynecology, University of Ottawa, Ottawa ON.
authors.forename: David S
authors.initials: DS
authors.lastname: Smithson
mesh_terms: D005260:Female; D006801:Humans; D009774:Obstetrics / Q000379:methods*; D009775:Obstetrics and Gynecology Department, Hospital / Q000706:statistics & numerical data*; D062072:Patient Acuity; D011247:Pregnancy; D011248:Pregnancy Complications / Q000145:classification* / Q000175:diagnosis*; D015203:Reproducibility of Results; D014218:Triage / Q000379:methods*
keywords: Obstetrical triage; reliability; validity