Advertisement

Evaluating the implementation of the Birmingham Symptom-specific Obstetric Triage System (BSOTS) in Australia

Published:September 18, 2022DOI:https://doi.org/10.1016/j.wombi.2022.09.005

      Abstract

      Background

      Obstetric triage is usually undertaken by a midwife and involves conducting a physical assessment to identify a woman’s presenting problem. The Birmingham Symptom-specific Obstetric Triage System (BSOTS) was developed in the United Kingdom (UK) to overcome challenges associated with triaging women by standardising the maternity triage process. The Australian study site is the first hospital outside the UK to implement this approach.

      Aim

      To evaluate the implementation of the BSOTS in an Australian tertiary maternity service.

      Methods

      A multi-method approach including pre-implementation BSOTS education evaluations (n = 26), post-implementation clinical data audit (n = 660), and staff focus groups (n = 9) was undertaken. Participants included midwives who worked in the Maternity Assessment Centre. Data of women who had attended the service during BSOTS implementation was analysed in the audit component.

      Findings

      Staff valued the BSOTS standardised approach to maternity triage, particularly for midwives new to the role. The retrospective audit showed that time to triage and time to care outcomes for women improved from pre-implementation audits and were mostly adhering to auditable standards. Lack of knowledge amongst staff (especially medical staff) regarding the BSOTS was considered a barrier to the effective flow of care of women through the centre.

      Discussion

      The BSOTS is a useful approach for prioritising women’s care. Ensuring that all staff are aware of the system and its benefits is likely to enhance implementation and improve triage outcomes.

      Conclusion

      The BSOTS is an innovative midwife led practice change that is applicable to the Australian context, and benefits women, midwives, and the maternity service.

      Abbreviations:

      BSOTS (Birmingham Symptom-specific Obstetric Triage System), MAC (Maternity Assessment Centre)

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Women and Birth
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Johns N.
        • Kenyon S.
        • Goodwin L.
        Birmingham Symtom Specific Obstetric Triage System Training Manual: For Midwives and Obstetricians.
        Birmingham Women’s and Children’s NHS Foundation Trust and University of Birmingham, 2017
        • Kenyon S.
        • Hewison A.
        • Dann S.-A.
        • Easterbrook J.
        • Hamilton-Giachritsis C.
        • Beckmann A.
        • et al.
        The design and implementation of an obstetric triage system for unscheduled pregnancy related attendances: a mixed methods evaluation.
        BMC Pregnancy Childbirth. 2017; 17https://doi.org/10.1186/s12884-017-1503-5
        • McCarthy M.
        • McDonald S.
        • Pollock W.
        Triage of pregnant women in the emergency department: evaluation of a triage decision aid.
        Emerg. Med. J. 2013; 30: 117-122https://doi.org/10.1136/emermed-2011-200752
      1. National Institute for Health Care Excellence, Safe Midwifery Staffing for Maternity Settings; NICE Guideline NG4 2015. Available from: 〈https://www.nice.org.uk/guidance/ng4/chapter/1-Recommendations〉.

        • Rashidi Fakari F.
        • Simbar M.
        • Zadeh Modares S.
        • Alavi Majd H.
        Obstetric triage scales; a narrative review.
        Arch. Acad. Emerg. Med. 2019; 7e13
        • Angelini D.
        • Howard E.
        Obstetric triage: a systematic review of the past fifteen years: 1998-2013.
        MCN Am. J. Matern. Child Nurs. 2014; 39: 284-297https://doi.org/10.1097/nmc.0000000000000069
        • Moudi A.
        • Iravani M.
        • Najafian M.
        • Zareiyan A.
        • Forouzan A.
        • Mirghafourvand M.
        Obstetric triage systems: a systematic review of measurement properties (Clinimetric).
        BMC Pregnancy Childbirth. 2020; 20https://doi.org/10.1186/s12884-020-02974-0
        • McCarthy M.F.
        • Pollock W.E.
        • McDonald S.J.
        Implementation of an obstetric triage decision aid into a maternity assessment unit and emergency department.
        Women Birth. 2022; 35: e275-e285https://doi.org/10.1016/j.wombi.2021.06.001
      2. Birmingham Women’s and Children’s NHS Foundation Trust, University of Birmingham, Birmingham Symptom Specific Obtetric Triage System (BSOTS): Training Manual for Midwives and Obstetricians. Birmingham, 2017.

      3. Western Health, Women's Services DG-CC2 Maternity Triage–Maternity Assessment Centre Departmental Procedure/Guideline. Melbourne: Western Health 2022.

        • Braun V.
        • Clarke V.
        Using thematic analysis in psychology.
        Qual. Res. Psychol. 2006; 3: 77-101https://doi.org/10.1191/1478088706qp063oa
        • Martin G.P.
        • Weaver S.
        • Currie G.
        • Finn R.
        • McDonald R.
        Innovation sustainability in challenging health-care contexts: embedding clinically led change in routine practice.
        Health Serv. Manag. Res. 2012; 25: 190-199https://doi.org/10.1177/0951484812474246
        • Dadich A.
        • Piper A.
        • Coates D.
        Implementation science in maternity care: a scoping review.
        Implement. Sci. 2021; 16https://doi.org/10.1186/s13012-021-01083-6
      4. Birmingham Women’s and Children’s NHS Foundation Trust, New Obstetric Triage System Launched Across the NHS Birmingam: Birmingham Women’s and Children’s NHS Foundation Trust, 2021. Available from: 〈https://bwc.nhs.uk/news/new-obstetric-triage-system-launched-across-the-nhs-3237/〉.