Select campus:UKDubai
University of Birmingham
Menu
Woman in white dress pregnant expectant mum holding tummy

How does BSOTS work?

Woman in white dress pregnant expectant mum holding tummy

Care is divided into 2 stages to ensure accurate, efficient care and smooth throughput of women:

Initial assessment

On attendance at triage, all women are seen by a midwife within 15 minutes of arrival. A brief standardised assessment is performed, which takes about 5-10 minutes, and will identity the primary reason for attendance. Using the BSOTS algorithms, the midwife will also define a category of clinical urgency (red, amber, yellow or green).

Primary reasons for attendance:

  • Abdominal pain
  • Antenatal bleeding
  • Hypertension
  • Postnatal concerns
  • Reduced fetal movements
  • Suspected labour
  • Ruptured membranes
  • Unwell/other

Ongoing care

Any further care is provided by a second midwife, guided by the relevant BSOTS algorithm, according to the primary reason for admission and clinical urgency. Ongoing care tasks can be personalised to your unit. Some women may move back to the waiting room while they await further care, to keep triage rooms free for more urgent cases.

An image with a flow chart describing the assessment triage process within the BSOTS system. Explained fully in the drop-down box below the image.

Accessible graphic description

BSOTS method

  1. Undertake a standardised assessment (triage) within 15 minutes of arrival
  2. Select the appropriate symptom-specific Triage Assessment card
  3. Define the level of clinical urgency using the symptom-specific algorithm.
    1. Red: Immediate care required
    2. Orange: For ongoing care within 15 minutes
    3. Yellow: For ongoing care within 1 hour
    4. Green: for ongoing care within 4 hours.

Women with Red and Orange assessment cards will be moved to an appropriate place for ongoing care (e.g. transferred to Labour Ward or remain in a clinical area within triage).

Women with Yellow and Green assessment cards will return to the waiting area to await ongoing care (thus keeping clinical areas free for more urgent cases).

How BSOTS works in maternity triage

A brief summary of BSOTS

Advice on successfully implementing BSOTS

BSOTS is a relatively simple tool, but may require system-level change within your maternity unit to run successfully. The tool below is designed to help you assess your current triage department, and give suggestions of things that could be changed to help BSOTS be implemented more effectively.

We have created a detailed Implementation Plan, accompanied by training and extensive resources, to enable you to successfully implement and maintain BSOTS in your unit. The areas below are all important in successful implementation:

  • Buy-in from your whole team, from the senior leadership to the midwives working in triage
  • The physical space of triage to provide a waiting area, dedicated triage room, and space for ongoing care
  • A clear identity for triage as the emergency portal, which may mean moving any scheduled appointments or non-emergency care away from triage
  • Initial and ongoing audits of triage to review the service and inform staffing
  • Increasing midwifery and obstetric staffing in triage to recommended levels
  • Changes to working patterns to ensure triage is suitably staffed by midwives and doctors
  • Ensuring triage staff are not used for escalation staffing in the first instance
  • Training for implementers of BSOTS and staff working in triage with the new system.