The successful implementation of BSOTS depends on leadership and commitment. This may be a big change for your unit, and it is really important for your senior managers to agree to the implementation and understand what is involved, as well as the midwife and obstetrician who are going to lead the change.

We strongly recommend that you build a case for the need for BSOTS, and get the support of all the staff members listed before implementing this change.

For BSOTS to be used successfully, there needs to be recognition that maternity triage is the emergency portal of your unit, for pregnant or newly postnatal people with unscheduled emergency concerns or problems. Ideally Triage should not be considered part of your day assessment area (eg. DAU, ADU, FAU) or any other department, as it needs to have protected staffing and ways of working.

It’s important that there is a single place for all pregnant or newly postnatal people with unscheduled, emergency problems to attend. This can ensure it is staffed appropriately. It is also important to have a clear pathway for women with unscheduled, emergency problems, which is consistent 24/7.

It’s important to know how many people attend your triage department so you can plan adequate staffing and space to run BSOTS. This information can also help you make a business case for additional staff, if needed.

The triage area should only care for people with unscheduled, emergency concerns. These people should not be seen by the same staff as women who are attending for any other reason, as this will divide the staff’s priorities and could potentially delay the assessment and care of emergency cases. If necessary, people attending for other reasons can be seen in the same area, provided there is enough room and staffing is separate to triage.

It is essential that your triage department has an adequately sized waiting area. This is especially important for BSOTS because following their initial triage assessment, some people will return to the waiting area while they await their ongoing care.

The waiting area should be visible to clinical staff for safety.

We recommend you use a whiteboard in your triage office/handover room. This will enable staff to visually monitor how many patients are in triage, how many are waiting to be seen, and whey are waiting.
If you monitor acuity electronically, we recommend a large wall-mounted monitor be available, that allows multiple staff members to quickly see the pertinent information to manage triage effectively.

BSOTS requires all women attending Triage to have an initial assessment performed within 15 minutes of their arrival. This is easiest with a dedicated single room for initial assessments only.

Fabulous!

Our experience suggests that for BSOTS to run effectively you will need at least 1 ‘ongoing care’ bed for every 1000 births in your unit. Your answer indicates that you should have enough beds for the ongoing care of people attending triage.

We strongly recommend that your triage phone line is located somewhere away from the clinical triage area - at least during the busiest times of day. This will ensure that midwifery staff are not distracted from the clinical work within triage, by regularly answering the phone.

It is really important that your triage phone line is answered by midwives, so appropriate clinical advice can be given to all callers.
If your phone line is initially answered by anyone else (eg. maternity support workers), they should pass ALL calls to a qualified midwife to give appropriate advice, and they should not be informally triaging women and only passing across those calls they deem necessary to speak to a midwife.

We strongly recommend you agree on standardised advice for those answering the triage phone line. This will ensure all callers receive the same information, regardless of who they speak to. It also guarantees that the latest evidence-based advice is given by all staff members, as agreed at a senior level.

Please note: Standardised advice is meant to support clinical midwives in providing consistent, standardised responses to triage phone calls. It is not intended to be used by non-clinical staff, as individual assessment and clinical judgement is still needed.

For the size of your unit, we recommend the following midwifery staffing in triage at a minimum:

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It is vital for BSOTS to run properly that triage is adequately staffed. Local midwifery staffing numbers and skill mix will depend on how busy the triage department is, and may vary with different shift times throughout the day. The priority must be to undertake the initial triage within 15 minutes of arrival, and numbers of staff will therefore depend on the numbers of women that attend. We recommend completing a thorough audit to identify which times of day are busiest, to adjust staffing accordingly.

For the size of your unit, we recommend the following obstetric cover in triage at a minimum:

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It is vital for BSOTS to run properly that triage has sufficient obstetric cover. This is essential to ensure pregnant people are reviewed within the appropriate timelines according to their clinical urgency. Sufficient obstetric cover will also ensure good throughput of patients and prevent bedblock with Triage. We recommend completing a thorough audit to identify which times of day are busiest, to adjust staffing accordingly.