Maternity improvement resource

What we look for

Safe

Safe systems, pathways and transitions

Telephone triage:

• How are you assured telephone triage is effective?
• What is the current performance of telephone triage?
• What systems do you have in place to monitor call times and call drop-offs?
• How does the monitoring of call times and drop-offs drive improvement in the service?

In-person triage:

• How are you assured women's care and treatment are assessed and prioritised effectively?
• Can you talk us through the triage process including:
  • your use of standardised tool
  • how you prioritise women.
• How are you assured handover care to other areas is effective?

Safe environments

• How are you assured equipment is checked to ensure it is fit for purpose and ready for use in an emergency?
• How are you assured a ligature point risk assessment of the environment has been completed?
  • Can you please show us the latest assessment?

Safe and effective staffing

• How are you assured triage staffing and acuity issues feed into the maternity unit safety huddle?
• How are you assured staff are appropriately trained to work in maternity triage?
• How are you assured staff are appropriately trained and competent in telephone triage
• How are you assured there is appropriate staffing levels in maternity triage?

Effective

Assessing needs and delivering evidence-based care and treatment

• How are you assured staff are able to access diagnostic results in a timely manner?
• How are you assured staff are completing MEOWS for clinical observations and escalating appropriately?
• How do you ensure triage standards, systems and processes are continuously reviewed and adapted as new evidence or information emerges?

Monitoring and improving outcomes

• How are you assured women are seen in a timely way, prioritised and escalated effectively in line with your own policy?
• How are the results of these audits shared?

How staff, teams and services work together

• Are there dedicated obstetric staff for triage?

Consent to care and treatment

• How are you assured staff ask for consent before any assessment of women?
• How is this recorded and monitored?

Caring

Kindness, compassion and dignity

• Are women given news of poor outcomes with dignity and in a private space?

Responsive

Equity in access

• What is the process for assessment of women who attend triage without an appointment?
• How is triage reviewed to ensure equity of access, for example using ethnicity data or serious incident data? 

Well-led

Capable, compassionate and inclusive leaders

• Is there a dedicated leadership for maternity triage?

Governance, management and sustainability

• How are you assured processes in telephone triage are effective?
• Do telephone triage audits include:
  • completeness of the record
  • appropriate prioritisation/RAG rating.
  • What is the current performance?
• How are you assured processes in maternity triage are effective?
• Do maternity triage audits include:
  • completeness of record
  • time of arrival
  • time of assessment by midwife
  • time of review by Obstetric team
  • time of discharge
  • appropriate prioritisation/RAG rating
  • is the service meeting its own policy or guideline?
• Can you tell us the interval between:
  • arrival to initial assessment
  • initial assessment to full assessment by a midwife
  • from assessment to obstetric review.
• What is the current performance of triage?
• How do you monitor maternity triage audits?
• How are you assured audit results are shared and improvements made?
• Is there board oversight of maternity triage performance?

The importance of people's experience.

• How are you assured the views of women using the service and the Maternity and Neonatal Voices Partnership (MNVP) have been used in developing maternity triage?
• How has engagement taken into account views of women who might face more barriers in triage? For example, women who do not speak English as a first language or women with mental health needs.