Unlike mainstream emergency medicine, there is currently no standardised triage system within maternity for women who attend for unscheduled appointments. Women are usually seen in the order in which they arrive, which can result in delays. This lack of clinical prioritisation can also cause safety issues as women who need urgent care may be seen after those with minor concerns. The Birmingham symptom-specific obstetric triage system (BSOTS) was co-produced in 2013 by midwives and obstetricians from Birmingham Women’s and Children’s NHS Foundation Trust and researchers working on the CLAHRC maternity theme at the University of Birmingham. The system is based on established triage systems in emergency medicine and uses an assessment with clinical prioritisation of the common reasons that present within maternity triage.
An initial standardised assessment of each woman identifies her presenting condition, key clinical symptoms and physiological indicators. Symptom-specific prioritisation algorithms use this information to define the level of clinical urgency using a four-category scale; green (non-urgent), yellow (requires further assessment), orange (priority) and red (emergency).
Initial evaluation of the implementation of this system suggested increases in the numbers of women seen within 15 minutes of arrival, reductions in the time spent waiting for assessment and the interval between attendance to medical review for those requiring it. Numbers of women who re-attended, and when they were next seen by maternity services suggested validity and improved safety. The system had excellent inter-rater reliability and midwives felt it improved safety for mothers and babies and the organisation of the Department.
Two further training days will take place later in the year and there has also been interest expressed from maternity units in other parts of the UK
Contribution of CLAHRC West Midlands
The first of three training days has taken place and was attended by clinicians from Heart of England, Worcester and Southampton. The Maternity theme researchers in CLAHRC WM were instrumental in setting up and delivering the training and in organising the overall programme of events. The provision of such workshops is critical as it enables full training to be given with participants able to discuss how cases might be handled and how different scenarios might be managed, while the willingness of clinicians to devote time to attending the training indicates a commitment to employing the system as effectively as possible.
What happened next?
There has been considerable interest in this triage system. Two further training days will take place later in the year and there has also been interest expressed from maternity units in other parts of the UK. There has also been interest from Australia and New Zealand, indicating that this research has an international reach. Professor Sara Kenyon has recently returned from a visit to these countries during which she had the opportunity to discuss the system in more detail with stakeholders.