The Development of a Screening and Referral System for Obstetric Emergencies with in the Primary Healthcare Network

Abstract

Purposes: To study the existing problems, develop a system, and evaluate the outcomes of implementing an obstetric emergency triage and referral system within the primary care service network of Pathumrat Hospital.

Study design: Research and Development - R&D.

Materials and Methods: The study sample consisted of: (1) 30 pregnant women who received antenatal care at Pathumrat Hospital, and (2) a focus group of 10 participants, including 4 nurses and medical personnel from Pathumrat Hospital, 2 district public health officers, and 4 pregnant women attending antenatal care services. The study was conducted in four phases between January and February 2025. The research instruments included: (1) a questionnaire, (2) an assessment form for appropriateness and feasibility, (3) a screening and referral system for obstetric emergencies within the primary care network of Pathumrat Hospital, and (4) an outcome evaluation form for the implementation of the screening system. Quantitative data were analyzed using descriptive statistics, including frequency, percentage, mean, and standard deviation. Additionally, the Priority Needs Index (PNI) was calculated, with values greater than 0.20 indicating significant needs for development.

Main finding: 1. The overall level of problems in obstetric emergency triage and referral was high (Mean = 3.98, SD. = 0.74). The highest Priority Needs Index (PNI) was related to the development of effective communication and coordination systems among referring units (PNI = 0.464), highlighting the critical importance of network communication and collaboration. 2. The developed obstetric emergency triage and referral system within the primary care network of Pathumrat Hospital comprised five components: triage system, clinical assessment and care during referral, referral system, support system, and monitoring and evaluation system. The overall appropriateness and feasibility were rated at high levels (Mean = 4.18, SD. = 0.64; Mean = 4.21, SD. = 0.62).  And 3. The overall outcomes in terms of health recovery following the implementation of the system were at a high level (Mean = 4.20, SD. = 0.45).

Conclusion and recommendations: After developing the system, the results demonstrated improvements across all six health outcome dimensions, which were rated at good to very good levels. Therefore, the system should be implemented in healthcare settings with similar contexts, along with strengthening personnel capacity and utilizing standardized tools to enhance the efficiency and quality of care.