Professor Sara Kenyon highlights role of triage to improve safety and trust for families among recommendations in National Maternity and Neonatal Investigation.
The voices of both families and clinicians are loud and clear in Baroness Amos’ landmark report following the Independent Investigation into Maternity and Neonatal Services in England.
Across the significant and weighty report, Baroness Amos makes a series of recommendations to address “the systematic problems identified” and “materially and sustainably” improve maternity and neonatal care.
Among the report, I am particularly pleased - and relieved - to see some recommendations in relation to designing a Modern Service Framework that reflect the work I and colleagues have done at the University of Birmingham over decades to develop an evidence-based maternal triage system.
I want to reflect on three key reasons why Baroness Amos’ recommendations can make significant improvements in safety for families through better use of triage services.
First, Baroness Amos has highlighted how maternity triage is recognised formally as a critical area of safety which is a hugely important step.
The report states:
Maternity triage must be formally designated as a safety-critical clinical environment, with binding national standards rather than guidance.
As a former midwife and researcher leading clinical trials and evaluations of services, this recommendation will shift the emphasis of triage services from being implemented on an ad-hoc basis without the required resource, to an ‘essential’ element of safety. Triage is the building block of clinical care, so the endorsement of recommendations from bodies into binding national standards is hugely welcome.
As a former midwife and researcher leading clinical trials and evaluations of services, this recommendation will shift the emphasis of triage services from being implemented on an ad-hoc basis without the required resource, to an ‘essential’ element of safety.
Triage is the building block of clinical care, so the endorsement of recommendations from bodies into binding national standards is hugely welcome.
Second, the report recommends much stricter accountability from boards about the use of triage services for maternal care:
Clear board oversight must be in place within trusts about the operation of the triage service, including regular reviews of waiting times, performance and implementation of actions to improve the service where identified.
From years of evaluation of services and schemes, one of the biggest areas that limits the effectiveness of interventions is senior buy in and accountability. As a result, Baroness Amos’ recommendation will not only ensure that Boards are regularly aware of data coming from triage services, but ultimately be judged on how well Trusts perform.
This is likely to result in much more scrutiny on the staffing, training and cover for maternity triage services and will ensure that they are adequately resourced.
Third, and closest for me, is the recommendation for an evidence-based tool for triage:
Within 12 months, an evidence-based tool should be mandated as the national triage standard across all NHS maternity units, with compliance monitored through regional and national maternity safety oversight.
Here at the University of Birmingham, we have developed the Birmingham Symptom-specific Obstetric Triage System (BSOTS) to standardise the assessment of women presenting themselves with unexpected pregnancy related problems or concerns, ensuring they are prioritised in order of clinical urgency.
First implemented at the Birmingham Women’s NHS (now Birmingham Women’s and Children’s NHS Hospital Trust) in 2013, BSOTS is now used in 90% of English NHS Trusts, has been validated through academic peer review, and is recommended by the Royal College of Obstetricians and Gynaecologists.
For 14 years BSOTS has been developing as the most widely used maternal triage service in the UK – helping to ensure that many women and their families are promptly assessed and treated based on the best possible evidence.
As the government and policy makers in UK healthcare consider the next steps following Baroness Amos’ landmark report, families and clinicians can[SK1] be reassured that implementation of these recommendations will improve the safety for women when they attend maternity services with concerns.
Sara Kenyon, Emeritus Professor of Evidence Based Maternity Care, University of Birmingham.
Professor of Evidence Based Maternity Care
Profile for Sara Kenyon, Professor of Evidence Based Maternity Care, Department of Applied Health Sciences, University of Birmingham.
