Toward a Safer Obstetric Triage System: Phase One Analysis and Recommendations

Abstract

Background: Obstetric triage is a critical gateway for ensuring timely, safe, and patient-centered care for pregnant and postpartum women presenting through emergency services. In high-volume tertiary hospitals, inefficient triage workflows may result in delays, repeated assessments, increased left-without-being-seen (LWBS) rates, and compromised patient experience.

Purpose: The purpose of this nurse-led quality improvement project was to evaluate and improve the obstetric triage workflow at a tertiary hospital in the Eastern Province of Saudi Arabia by examining routing inefficiencies, identifying system-level root causes, and informing evidence-based redesign strategies guided by Lean methodology.

Methods: A Phase 1 diagnostic assessment was conducted using Lean methodology and Donabedian’s structure–process–outcome framework. Data sources included a retrospective audit of obstetric emergency presentations from June to August 2025, analysis of formal patient complaints, direct workflow observation, and multidisciplinary stakeholder input. Process-based indicators such as routing accuracy, waiting times, LWBS rates, and safety signals were analyzed descriptively.

Results: Approximately one quarter of obstetric patients experienced repetitive routing between the Emergency Department and obstetric triage, resulting in an average additional delay of 50 minutes per case. While time to initial nurse assessment met international benchmark standards, downstream inefficiencies contributed to elevated LWBS rates in obstetric triage compared with the Emergency Department. Root cause analysis identified structural capacity constraints, fragmented governance, restricted nursing authority, policy gaps, and limited digital integration as primary contributors to these inefficiencies.

Conclusion: Phase 1 findings demonstrate that obstetric triage inefficiency in this setting is systemic rather than behavioral. The results establish a robust evidence base for Lean-informed, nurse-led redesign strategies, including workflow standardization, role clarification, and system-level process optimization, to enhance patient safety, operational efficiency, and maternal care quality.