O66 - Evaluation of the implementation of the Birmingham Symptom-specific Obstetric Triage System (BSOTS) in an Australian maternity service

Abstract

Obstetric triage is usually undertaken by a midwife and involves identifying the woman’s presenting problem and conducting physiological and vital signs assessment. Triage of a pregnant woman poses challenges, as the physiological changes associated with pregnancy do not match the general parameters of standard emergency department triage measures. For these reasons, the Birmingham Symptom-specific Obstetric Triage System (BSOTS) was developed to standardise triage within maternity care. The BSOTS is currently being rolled out in all National Health Service maternity hospitals in the United Kingdom, however our site is the first in Australia to trial this approach. The aim of the study was to evaluate the implementation of the BSOTS in an Australian tertiary maternity service. A mixed-methods approach including surveys, focus groups, and retrospective data audit was undertaken. Participants included midwives and doctors who worked in the Maternity Assessment Centre (MAC) and women who had attended the MAC during the BSOTS implementation. Key outcome measures included: • knowledge and confidence in using BSOTS following the pre-implementation education • time to triage and time to treatment for women in accordance with the BSOTS prioritisation of care • staff experiences and satisfaction of the BSOTS implementation • women’s satisfaction of triage following the BSOTS implementation The findings showed that staff valued the BSOTS standardised approach to maternity triage. The clinical audit showed that women’s time to triage and treatment times were generally being achieved within auditable standards. Almost all women were satisfied with their experience of triage. Lack of knowledge amongst staff (especially medical staff) regarding the approach was perceived to be a barrier to effective implementation. The implementation of the BSOTS demonstrates an innovative midwife led practice change. The BSOTS is applicable to the Australian context, benefiting women, midwives, and the maternity service.