"Reimaging a triage system with midwives, for midwives": exploring preferences for a midwife-Led triage system in South Africa through a user-centered approach.

Introduction: Triage in the maternity unit is critical to ensuring the delivery of timely and appropriate care. It is regarded as an initiative to reduce maternal mortality by accelerating the provision of appropriate care at the appropriate time. However, maternity units in South Africa lack standardized triage systems. Most pregnant women often wait for hours and days upon arriving at the hospital. This delay could prove costly for complicated pregnancies and childbirth. Therefore, this paper aims to explore the preferences and needs of midwives for a midwife-led triage system in South Africa. Methods: A user-centered design approach underpinned this study, focusing on the requirement gathering stage to fully understand the needs and preferences of midwives for an ideal midwife-led triage system. A sequential exploratory research design within the user-centered design framework was used. Experienced midwives were selected to participate in the study. Semistructured interviews and surveys were used for data collection, which were then analyzed using thematic analysis and descriptive statistics. Results: The study found that midwives had different needs and preferences for an ideal digital system. Two principal themes emerged from data integration, namely, triage contents and features of the midwife-led triage system and the application and functionality features of the midwife-led triage system. The study underscored the importance of including clinical profiles, patient profiles, clinical histories, and the designated area for subjective data such as chief complaints. In addition, the midwives expressed the need for the digital triage system to share information and be linked to primary healthcare facilities and laboratories to access patient results. They also highlighted the need for the system to provide clinical management guidance by incorporating maternal guidelines, addressing concerns about poor skills and incompetence among some midwives. The study underscored that preferences of midwives are shaped by their experience and the existing environment. Conclusion: Therefore, this paper suggests that the preferences, needs, and ideas of midwives should be integrated into the digital triage application to create a new quality triage system for maternity units in South Africa. Furthermore, relevant stakeholders should provide the resources required to navigate a smooth triaging process of patients with the midwife-led system.