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Birmingham Symptom specific Obstetric Triage System (BSOTS)

Lead: Prof Sara Kenyon

Public contributors in ARC WM's Maternity theme have been involved in the development, evaluation and roll-out of the maternity triage system.

Dates: 2011 - ongoing


The triage departments within maternity care have developed without standardised processes or pathways, and continue to expand in workload without appropriate organisational and clinical systems. This means that women may have to wait to be seen in the order in which they arrive (often with informal triaging based on obvious need) without clinical assessment until they are seen – this is neither safe nor effective. There are around 600,000 births each year in the UK, which translates to between 1,200,000 and 1,800,000 triage attendances, and thus a huge potential to improve safety.

Policy and Practice Partners:

Royal College of Midwives, Royal College of Obstetrics and Gynaecologists, West Midlands Academic Health Service Network (WM-AHSN), and national Maternity Units.

Co-Funding Partners:

WM-AHSN and multiple NHS implementation units.

Aims and Objectives:

The Birmingham Symptom specific Obstetric Triage system (BSOTS) was co-produced by clinicians (obstetricians and midwives) and researchers at Birmingham Women’s and Children’s NHS Foundation Trust and the University of Birmingham (CLAHRC WM/ARC WM). The system is based on the established triage systems used in emergency medicine and uses a uniform assessment and clinical prioritisation of the common conditions that women present with in maternity triage (Kenyon, et al. BMC Pregnancy Childbirth. 2017;17(1):309).


BSOTS consists of a prompt and brief assessment (triage) of the women on presentation, and then a standardised way of determining the clinical urgency in which they need to be seen. Women found to have a lower clinical priority can be sat back in the waiting room, thus improving the pathway, and the standardised assessment and excellent inter-rater reliability means variation in the clinical urgency of women between midwives is minimal. The shared language between health care professionals supports clear communication. The system can be amended to personalise it to individual maternity units but the principle that the assessment is a triage (ie both prompt and brief) and the algorithms (which are used to define the women’s clinical priority) cannot be changed.

Main Results:

Following a Consensus meeting between academics, policy makers and professional bodies in 2017 it was agreed the positive benefits and lack of potential harm meant roll out should be facilitated without further evaluation. Implementation is supported by the Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives. The Birmingham Symptom specific Obstetric Triage System (BSOTS) has been implemented in 45 maternity units in the UK with a further 50 in the process of implementation. Sunshine Hospital in Victoria, Australia is the first international maternity unit to implement BSOTS with interest from others. BSOTS was awarded Academic Health Service Network West Midlands (AHSN WM) Meridian Awards for Safety and Innovation in July 2019 and won the Health Service Journal (HSJ) Patient Safety Award for Maternity and Midwifery Services Initiative of the Year in November 2020.


BSOTS improves safety for mothers and babies attending maternity care triage with concerns and improves the working environment for clinicians by providing a system for identifying and prioritising women based on clinical criteria. A recent move to remote access to training and implementation materials further supports more widespread roll out.

Implications for Implementation:

We will continue our successful roll-out of this intervention at home and abroad in collaboration with local commissioners, the WM-AHSN, and the Royal College of Obstetricians and Gynaecologists, and the Royal College of Midwives.

Training and support materials to successfully implement BSOTS are available on the website (BSOTS Public Page).

BSOTS is also available on BadgerNet EPR and if you want to implement BSOTS you will need to follow the process detailed on the website (for information please click to the link BSOTS Public Page). We are also working with AllScripts, Cerner, K2, EuroKing, EPIC, and System C to intergrate BSOTS into their maternity Electronic Patient Records (EPR).

Thu 14 Jan 2021, 13:00 | Tags: Sara Kenyon Maternity