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PA.31 Midwives views of the implementation of the Birmingham Symptom-specific Obstetric Triage System (BSOTS)
  1. J Easterbrook1,
  2. A Hewison2,
  3. N Johns1,
  4. S Kenyon2
  1. 1Birmingham Women’s NHS Foundation Trust, Birmingham, UK
  2. 2University of Birmingham, Birmingham, UK


Background The need to develop a standardised triage system to prioritise clinical urgency of women when unscheduled pregnancy related attendances occur has been identified.1 We have developed, implemented and evaluated a uniform system, similar to those used in Accident and Emergency2 departments. This involves a standardised initial triage assessment (within 15 min15 minutes of arrival) to identify level of clinical urgency and provision of standardised immediate care and investigations.

Method To investigate midwives’ views and experiences of the implementation of BSOTS two focus group interviews were held with midwives (12) and a questionnaire sent to midwives working in triage in autumn 2013. Ethical permission was obtained from the University of Birmingham Ethics Committee. Thematic analysis of the focus group data was used to develop a questionnaire. The response rate was 53/79 (67%) and data was analysed using descriptive statistics.

Results The midwives felt the introduction of the new system had gone well and helped them manage and organise the department. Midwives reported the safety of the woman and baby had been improved and the system allowed them to continue to use their clinical judgment, despite it being standardised. The evaluation identified midwives’ concerns about the use of a validated pain score which affected their use of the system. As a result this has been replaced with assessment of pain being based solely on clinical judgement. Practical changes to the paperwork have also been made.

Conclusion The results from this study demonstrate the benefit of involving clinicians’ in service improvement.


  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

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