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Birmingham Symptom Specific Obstetric Triage System

We have trained maternity teams to carry out the Birmingham Symptom Specific Obstetric Triage System to prioritise those with urgent clinical needs.


Birmingham Symptom Specific Obstetric Triage System (BSOTS) was developed in 2013 by midwives and obstetricians in Birmingham Women’s and Children’s NHS Foundation Trust, and researchers from the University of Birmingham. Before this system was introduced, the hospital reviewed women in order of attendance rather than their clinical presentation, meaning that women with urgent clinical need were not prioritised.

BSOTS enabled an initial standardised assessment of each woman, identifying her presenting condition, key clinical symptoms and vital signs. This information was then used to define the level of clinical need using a four-category scale: green (non-urgent), yellow (requires further assessment), orange (priority) and red (emergency).

As part of our work to support the national NHS England and NHS Improvement Maternity and Neonatal Safety Improvement Programme (MatNeoSIP), we have trained nine maternity teams to carry out BSOTS.

How did the programme work?

BSOTS was rolled out in two waves, with nine trusts attending the one-day training. We  held practice sessions every three months to help learn from successes and troubleshoot across the region. We continue to provide support, address challenges and track impact through our Community of Practice for the teams.

Teams participating in the programme were  given additional support including:

  • Delivery of 1-day train the trainer BSOTS session
  • Access to a regional obstetric lead for clinical guidance
  • Regular support through individual contact, webinars and knowledge exchange through a community of practice
  • Access to improvement advisors for quality improvement support and troubleshooting
  • Human factors training
  • Support with the MatNeoSIP programme through local learning system and individual support
  • Culture surveys pre and post implementation, to assess staff morale and burnout

Find out more

Watch: How BSOTS works in Maternity Triage

If you would like further information on BSOTS, please contact

Paulina E. Sporek de Lacerda, Maternity Improvement Advisor. Email: