RCOG World Congress 2023

Maternity Triage and Day Assessment Unit: Experiences Before and After BSOTS Implementation

Introduction

Birmingham Symptom Specific Obstetric Triage System (BSOTS) is a triaging system specific to obstetrics developed in 2013. It has been shown to improve patient safety and management of the department, with implementation supported by RCOG and RCM.

It was implemented in Whipps Cross Hospital in March 2023.

Results: Patient Survey (19 responses)

Key Highlights:

94.7% said that all staff were polite

94.7% felt that they were treated with compassion and kindness

94.7% felt their views/choices were valued and respected

78.9% would recommend the Triage/DAU service to others

Areas for Improvement:

47.4% said that they were seen within 15 minutes of arrival

15.8% reported that not all staff introduced themselves

47.4% were not asked about their mental health

Results: Staff Survey (40 responses 71% Midwives, 19% Doctors, 10% Maternity Assistants and Student Midwives)

Key Highlights:

72.5% had access to psychological support

67.5% feel a valuable member of the team (mostly or always)

Majority said that they would like to see BSOTS implemented (with appropriate staffing)

Areas for Improvement:

35% reported not having opportunities to raise concerns

21.6% do not have their break regularly on duty

48.6% described their current morale level as low

Many reported increased staffing and training would improve the service

Overview of Targets

Out of the data available:

•93/117 (79%) of patients categorised as GREEN were seen within 4 hours

•68/167 (40.7%) of patients categorised as YELLOW were seen within 1 hour

•9/53 (16.9%) of patients categorised as ORANGE were seen within 15 minutes

Results

1.There has been an improvement in the mean waiting time and % of patients seen within 15 minutes by the Triage Midwife

2.For a doctor review, the mean waiting time to see a doctor prior to BSOTS implementation was 86.7 min. Following BSOTS implementation, 50% of patients were seen by a doctor within the recommended timeframe for the category rating.

3.The numbers of patients presenting to Triage have been increasing each month (by about 20%)

4.22% of patients seen in Triage were in the ‘Other’ category not covered by the standard Triage Assessment Card categories

Conclusions

1.The patient and staff sample surveys have been in favour of implementing the BSOTS triaging system and have been helpful in providing feedback that all staff can work on to improve overall patient and staff experience, a follow-up survey will be due after BSOTS fully established

2.The implementation of BSOTS after 1 month has already shown an improvement in the patients seen within 15 minutes of arrival to Maternity Triage

3.There is still a lot of work to be done to achieve the recommendations for timely review by a doctor in particular for the more urgent categories (Red, Orange and Yellow) and an urgent deeper dive into the reasons for delay need to be explored and addressed

4.Patients attending for the ‘Other’ categories need to have appropriate pathways in place so that referrals to Maternity Triage are appropriate

Next Steps

1.Process mapping the pathway to ensure that prospective data collection is from when the clock starts of arrival of the patient at the Triage reception, how escalation for doctor reviews happen and contributing factors to delays in reviews

2.Optimise the data collection process and the monthly audit posters to monitor targets

3.Conduct follow up analysis, including staff and patient feedback, 6 months after implementation

RCOG World Congress 2023

Maternity Triage and Day Assessment Unit: Experiences Before and After BSOTS Implementation

Poster Presenter

Authors

Affiliations

Part of Topic