Article Text

Download PDFPDF
PA.09 Evaluation of the implementation of the Birmingham Symptom-specific Obstetric Triage System (BSOTS)
  1. S Kenyon1,
  2. S Dann1,
  3. J Jeffery2,
  4. N Johns2
  1. 1University of Birmingham, Birmingham, UK
  2. 2Brmingham Women’s NHS Foundation Trust, Birmingham, UK


Background Confidential Enquiries1 and local audit have identified the need to develop a standardised triage system to prioritise clinical urgency of women when unscheduled pregnancy related attendances occur. We have developed, implemented and evaluated a standardised system, similar to Accident and Emergency.2 This involves a standardised initial triage assessment (within 15 min of arrival) to identify level of clinical urgency defined as red (see immediately), orange (see within 15 min), yellow (see within an hour) and green (see within four hours) and includes standardised immediate care and investigations.

Methods BSOTS was implemented following bespoke training in April 2013. Structured audit of maternal notes was undertaken of women who attended in June 2012 (before) and June 2013 (post) implementation. Sample size was powered to detect a 10% improvement with 90% power (5% significance). Primary outcome was number of women being assessed within 15 min of arrival. Secondary outcomes included time of subsequent assessments, care and investigations and birth outcome data.

Results Data was extracted from 972/994 notes available. Baseline characteristics of the women were similar for the two time periods. Primary outcome: improvement in the numbers of women seen within 15 min from 39% to 54% – 15% increase (95% Confidence interval (9, 22)). Breakdown into levels of urgency showed consistent improvement as did secondary outcomes, although missing data limited reliability.

Conclusions BSOTS significantly improved the numbers of women assessed within 15 min of arrival in triage and is likely to improve safety for women and babies.


  1. Centre for Maternal and Child Enquiries (CMACE). Saving Mothers’ Lives: reviewing maternal deaths to make motherhood safer: 2006–08. The Eighth Report on Confidential Enquiries into Maternal Deaths in the UK. BJOG 2011;118(Suppl. 1):1–203

  2. Mackway-Jones K. Emergency Triage: Manchester Triage Group. London: BMJ Publishing Group, London, UK, 1997

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.