DOI

10.21007/con.dnp.2026.0131

Faculty Advisor

Margaret Harvey, PhD, APRN, ACNP-BC, CHFN, FHRS

Document Type

Poster

Publication Date

Spring 4-21-2026

Disciplines

Health and Medical Administration | Investigative Techniques | Medicine and Health Sciences | Nursing | Nursing Administration | Quality Improvement

Abstract

Purpose/Background

Maternal morbidity and mortality remain persistent challenges in the United States, with obstetric triage serving as a critical point of entry for timely recognition and management of high-acuity maternal-fetal conditions. Despite recommendations for acuity-based triage models, many obstetric units continue to rely on non-specific emergency triage tools, such as the Emergency Severity Index (ESI), which inadequately account for pregnancy-specific physiological changes and fetal status. To address these limitations, the Association of Women’s Health, Obstetric and Neonatal Nurses developed the Maternal-Fetal Triage Index (MFTI), a five-level obstetric-specific triage tool. Although the MFTI has been increasingly adopted in clinical practice, the extent and quality of evidence supporting its measurement properties and clinical impact remain unclear. The purpose of this scoping review was to map and synthesize the existing evidence on the implementation, reliability, validity, and clinical outcomes associated with the use of the MFTI.

Methods

A scoping review was conducted in accordance with PRISMA-ScR guidance. Searches were independently conducted by two reviewers across PubMed, CINAHL, the Cochrane Library, ClinicalKey, and Google Scholar between October 2023 and November 2025. Eligible studies included quantitative, qualitative, mixed-methods, validation, descriptive, and quality- improvement designs evaluating obstetric triage tools, with a focus on the MFTI. Studies were limited to English-language publications involving pregnant persons in obstetric or hospital triage settings. Data were charted using standardized evidence tables and synthesized descriptively to identify patterns in implementation outcomes, measurement properties, and clinical relevance.

Results

Ten studies met the inclusion criteria. Across diverse clinical settings, implementation of the MFTI was consistently associated with decreased triage times, improved prioritization, enhanced workflow efficiency, and more transparent interdisciplinary communication. Foundational studies demonstrated strong content validity of the MFTI using item-level and scale-level content validity indices, while broader reviews supported content validity using the COSMIN framework. However, evidence supporting reliability was limited and methodologically inconsistent. Several studies emphasized that structured education and organizational support were critical to consistent triage scoring. While direct maternal and neonatal morbidity and mortality outcomes were rarely measured, improved early recognition of high-acuity conditions, including severe hypertension, was reported. Persistent gaps included limited multicenter research, underrepresentation of diverse clinical environments, and insufficient psychometric validation.

Implications for Nursing Practice

Findings support the MFTI as a promising standardized obstetric triage tool that improves timeliness and prioritization of care when implemented with adequate training and institutional support. In nursing practice, adopting the MFTI may enhance clinical decision-making, improve workflow efficiency, and facilitate early identification of high-risk maternal-fetal conditions. However, the limited reliability evidence underscores the need for continued evaluation, ongoing staff education, and rigorous multicenter research to strengthen the tool’s psychometric foundation. Advancing standardized obstetric triage practices has important implications for promoting safe, equitable, and high-quality maternal care.

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