Effective emergency care relies on the ability to triage patients quickly and assess risk to prioritise care. This requires dedicated infrastructure, such as appropriate space and staffing. Unlike general emergency departments, maternity services have lacked a formal, risk-based triage system for pregnant and early postnatal women and their babies. Because pregnant women are typically young and healthy, serious problems are often not obvious, and standard triage tools are unsuitable as they do not consider the unborn baby or the body’s adaptations to pregnancy. This usually results in women being seen in order of attendance, posing significant risk of harm to those who urgently need care. ARC WM developed the Birmingham Symptom specific Obstetric Triage System (BSOTS), led by Prof Sara Kenyon MBE (University of Birmingham) in collaboration with Dr Nina Johns (Birmingham Women’s and Children’s Hospital NHS Trust).
BSOTS is a maternity triage system specifically designed to improve safety for pregnant women and their babies attending maternity assessment units by providing a structured approach to triage. The system allows staff to assess risk in a timely manner and assign a category of urgency for those who need to be seen more quickly for further assessment. Since the launch in 2013, BSOTS has been adopted and implemented nationally across 133 units, being responsible for the triage of approximately 1.5 million women and 509,129 births annually, as well as expanding to Australia and New Zealand. BSOTS has transformed the management of maternity triage nationally, and improved safety for pregnant women and their babies.
BSOTS is recommended by the Royal College of Obstetricians and Gynaecologists as the national maternity triage system in the UK, and is also endorsed by the Royal College of Midwives and the Care Quality Commission. BSOTS has also received a number of awards/recognition, including from the Health Services Journal, the University of Birmingham Rose Sidgwick Award for External Engagement and Impact in the 2024 Founders’ Awards, and the University of Birmingham Impact award for Outstanding Contribution to Impact in Global Health 2025.
