Author: Eleanor Jones (Institute of Applied Health Research)

TELEPHONE TRIAGE ASSESSMENT CARD

1st Call

Telephone call taken by				Print Name										PIN
				Signature
				Date			Time							Location
Woman’s name														Woman’s Telephone number
Hospital no.										DOB
Gravida		Parity		EDD or / Date of delivery	D	D		-	M		M	-	Y		Y	Gestation	Days PN

Primary reason for calling Triage	Abdominal pain			Antenatal bleeding					Hypertension
	Postnatal concern			Ruptured membranes					Suspected labour
	Unwell/other			Reduced fetal movements
Relevant medical & obstetric history
Current pregnancy
Additional information (social , lifestyle history and ethnicity)
Advice given including / time-frame if you ask woman to attend triage
Plan / (please circle)	Phone ambulance; attend triage immediately	Attend triage (use own transport)			Referred to / CMW			Referred to / GP			Advised with no further action
Actions if woman advised to attend	Timeframe for woman to attend	Inform LW and medics if urgent attendance				Obtain Hospital notes

Specific early labour advice	Mobilise		Paracetamol		To call back if:
	Rest		Regular fluids		Any changes		PV Bleed
					Change in FMs		SROM
	Regular snacks		Warm bath		Increase in strength and/or frequency of contractions		Worried about anything

PLEASE ATTACH TO HOSPITAL NOTES AND FILE ON ADMISSION

TELEPHONE TRIAGE ASSESSMENT CARD

2nd Call

Consider Triage attendance

Primary reason for calling Triage	Abdominal pain			Antenatal bleeding					Hypertension
	Postnatal concern			Ruptured membranes					Suspected labour
	Unwell/other			Reduced fetal movements
Relevant medical & obstetric history
Current pregnancy
Changes since last call
Advice given including / time-frame if asked to attend triage
Plan / (please circle)	Phone ambulance; attend triage immediately	Attend triage (use own transport)			Referred to / CMW			Referred to / GP			Advised with no further action
Actions if woman advised to attend	Timeframe for woman to attend	Inform LW and medics if urgent attendance				Obtain hospital notes
Print Name & PIN		Signature								Date & time call completed

TELEPHONE TRIAGE ASSESSMENT CARD

3rd Call

Recommend Triage attendance

Primary reason for calling Triage	Abdominal pain			Antenatal bleeding					Hypertension
	Postnatal concern			Ruptured membranes					Suspected labour
	Unwell/other			Reduced fetal movements
Relevant medical & obstetric history
Current pregnancy
Changes since last call
Advice given including / time-frame if asked to attend triage
Plan / (please circle)	Phone ambulance; attend triage immediately	Attend triage (use own transport)			Referred to / CMW			Referred to / GP			Advised with no further action
Actions if woman advised to attend	Timeframe for woman to attend	Inform LW and medics if urgent attendance				Obtain hospital notes
Print Name & PIN		Signature								Date & time call completed

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