Abstract

Birmingham Women's NHS Foundation Trust established a triage service in 2004 in response to the large numbers of women who presented for an assessment. These assessments were not always labour related and interrupted the 1:1 care being provided by midwives. Although Triage was later perceived as successful because interruptions in labour were reduced, the separate department had a number of problems which emerged. The problems include: telephone triage, clinical decision-making, the woman's experience, staff experience and documentation.

The authors applied the clinical audit process to the Triage function. This gave us the opportunity to develop a rich vision of what good practice would constitute, including evidence based clinical practice, women's and staff views, structured telephone calls and targets from Accident & Emergency triage. In order to pave the way for improvement, the authors also considered what service the authors thought the authors were currently providing. The authors observed and measured actual practice, including quantitative measures of activity and qualitative exploration of the experience of the women and staff. This exploration also included listening to 100 clinical conversations between staff and women in order to assess the clinical content of the advice given as well as the quality of the call.

From this wide range of information, the authors derived a set of recommendations which are intended to answer the crucial audit question: ‘How can the authors consistently do what the authors should be doing?’ The authors tabulated the recommendations in a form which makes clear the relationship between good practice to which the authors aspire and what the authors do now.