Implementing risk-appropriate maternity care-based triage model at a tertiary care teaching institute: an organisational quality improvement initiative to optimise risk and resources.

BACKGROUND: The annual births in our hospital (a regional perinatal centre for the southeastern coastal region) had increased to nearly 19 000 in 2019, straining the resources. Reduced low-risk childbirths due to the restrictions during the COVID-19 pandemic gave us an impetus to design and implement a risk-appropriate triage model referral system. We report its implementation process and examine its effect on birth rates and quality of care. METHODS: Initially, the data on childbirths (2019) and the districts where the majority belonged were analysed. We discussed the need for triaging and the implementation process with these district health administrators. In the antenatal clinic, a dedicated team triaged and referred new cases to risk-appropriate facilities near their homes. Using WhatsApp groups, information about those referred back and the critically ill transferred to our hospital was shared. The impact of model implementation was assessed by the change in the number of births, proportion of high-risk cases, quality indicators and feedback from health workers. RESULTS: The average number of childbirths per month decreased from 1530 in 2019 to 900 in 2023 after the implementation of triage on 15 December 2022. The quality indicators, such as stillbirth and scar rupture, declined after implementation, but caesarean deliveries rose from 20% to 30%. Better satisfaction among personnel and a change in the pattern to more high-risk pregnancies were noted; there was a reduction in bed occupancy rates, averting overcrowding. CONCLUSION: A 'risk-appropriate maternity care-based triage model' could be implemented, reducing low-risk births and improving the quality of care for high-risk women in tertiary care institutes.