Date of Award

Spring 5-25-2019

Document Type

Doctor of Nursing Practice Final Manuscript

Degree Name

Doctor of Nursing Practice



First Advisor

Joseph Burkard, DNSc, CRNA



Ann Grimshaw, RN, MSN, CNS

Clinical Nurse Specialist

Doctorate of Nursing Practice, Student

University of San Diego, School of Nursing

San Diego, CA

Purpose: To reduce a patient’s knowledge deficit related to plan of care after an unscheduled obstetric triage through follow up phone calls.

Rationale and Background: Up to 75% women during their pregnancy will present to an unscheduled visit in obstetrical triage with questions about their own health and the health of their unborn newborn. The majority of these visits will result in discharge from obstetrical triage prior to delivery of the newborn. Patients who leave triage can display a knowledge deficit in the expectation in plan of care for needed follow up or not have the resources to available to fully complete the plan. This can lead to confusion for the patient and primary obstetrical provider, along with dissatisfaction of care after the visit. A follow up phone call can ensure proper follow up is coordinated along with clarification of the plan of care put in place from the unscheduled visit. Traditionally the response from an unscheduled visit is to leave responsibility with the patient to call their primary obstetrical provider for follow up and review of the visit and any testing preformed.

Best practice: Daily review of all obstetrical unscheduled visits at a major metropolitan tertiary care center by a team of obstetrical trained Registered Nurses. Patients identified from predetermined criteria to require follow up care are contacted by their primary obstetric care clinic nursing staff. The goal of the calls will be to review the visit with the patient in addition to coordinating needed follow up care. Patients will be asked three questions related to their understanding of the obstetrical visit, these questions will be based on five point Likert scale. These questions will be asked at the beginning of the call and again at the end of the call. This will gage the reduction of knowledge deficit from the patient about their recent visit.

Outcomes: After a three-month period, it was found that patient knowledge deficit decreased and patient’s reported increased understanding of the expected follow up plan of care after an obstetrical triage visit. It was also noted that an increase of 25% in the needed follow up visits with primary obstetric care providers were identified and booked as appropriate.

Conclusion: Follow up phone calls are shown to improve the overall understanding and satisfaction with the obstetrical triage visit, providing guidance to the obstetric patient coordinating follow up care and supporting a better understanding of recommendations of the obstetrical triage discharge plans. Obstetric patients who are released from an unscheduled visit prior to delivery are recommended to receive follow up care from their primary obstetric provider. Patient contact will support coordination of care and decreased knowledge deficit in regards to the obstetrical patient’s awareness of the maternal and fetal health.