Lead: Prof Sara Kenyon, Dr Nimarta Dharni, Dr Agnieszka Latuszynska, Prof Graeme Currie

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. Current implementation evaluation study November 2022- September 2023

Background:

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. The need to develop system to improve safety has been identified by CQC and Health Care Safety branch (HSIB, 2021 https://hsib-kqcco125-media.s3.amazonaws.com/assets/documents/HSIB_Maternity_programme_year_in_review_2020-21_Report_V29.pdf)

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) Link opens in a new window

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 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.

In November 2022 BSOTS had been implemented in 74 maternity units, with another 50 units expressing an interest in implementing the system. Upon publication of the Royal College of Obstetricians and Gynaecologists (RCOG) Good Practice Paper on Maternity Triage it will be the recommended system within England.

Policy and Practice Partners:

West Midlands AHSN. Royal College of Midwives, Royal College of Obstetrics and Gynaecologists, and national Maternity Units.

Co-Funding Partners:

Birmingham Women’s and Children’s Foundation NHS Trust (BWC) and multiple NHS implementation units.

Aims and Objectives: We are currently undertaking a study to explore the implementation, fidelity, reach, adoption and sustainability of the BSOTS maternity triage system.

Methods:

Design: a mixed methods study

Setting: maternity units in the UK who have implemented BSOTS or are in the process of doing so

Participant population: Midwives and Obstetricians involved in the implementation of BSOTS

Measures: Planned size of sample: 1) Quantitative survey: n=91 site leads, 2) survey with maternity triage staff from selected sites, 3) qualitative interviews/focus groups: 30-40 interviews or up to 8 focus groups with maternity triage staff and BSOTS development team and regional implementation leads

Analysis: Our evaluation will explore the implementation of BSOTS in practice using a blended approach that combines Proctor’s implementation outcomes5 and Normalisation Process Theory6 (NPT).

Main Results: Study currently underway-November 2022 to June 2023,

Conclusions: Study currently underway- November 2022 to June 2023,

Implications for Implementation:

We will continue our successful roll-out of this intervention at home and abroad

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).Link opens in a new windowLink opens in a new window We are also working with AllScripts, Cerner, K2, EuroKing, EPIC, and System C to intergrate BSOTS into their maternity Electronic Patient Records (EPR).

BWC are currently funding 2 part-time Band 7 midwives (one in the North and one in the South) to support implementation.