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

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.