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).
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