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Acuity* Assessment For Risk Management; Measuring Client Need With Number Of Midwives Available In Labour Ward.
In response to request from maternity units BR+ have recently developed and tested a measure whereby midwives and managers can assess their potential staffing needs on an hour by hour or shift by shift basis.
The main component of the acuity system is a score sheet, based upon the Birthrate Plus(R) score system which uses clinical indicators of the process and outcome of labour to allocate mothers and infant(s) to one of five outcome categories listed I - V. This however is used at the point at which the mother and infant leave the delivery suite.
For assessing initial and ongoing acuity BR+(R) has now produced a score sheet based upon the same indicators but the scoring has been changed to project the expected outcome category and thus to indicate the level of midwifery care required. This is completed on admission and can be updated if and when changes occur, and at the end of labour in order to verify the projected acuity level was correct.
A separate score sheet is used for other women admitted to the labour ward who do not give birth at that time i.e. Categories X, A1 (low risk antenatal) A2 ( high risk antenatal) T = transfers out with midwife in attendance and R= women readmitted for some procedure. The results are compiled via a ward management record which indicates the staff required and the staff available The score systems and ward management records have been extensively validated with the maternity services in Wales and a validity score of over 70% was set as the criterion for approval. In fact the validity was over 70% in all cases. Note; the validity score was based upon the number of time the projected acuity both on admission and updated for any change during labour was confirmed by the final category outcome of labour and delivery. The system can be used therefore to compare on a regular basis the number of midwives required to meet the needs of the women in the labour ward with the number available. The copyright of the acuity system belongs to Birthrate Plus(R) Consultancy Ltd. and further information can be obtained by contacting: Marie Washbrook on
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or Jean A Ball on
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* WE DEFINE ACUITY AS; The volume of need for midwifery care at any one time based upon the number of women in labour and their degree of dependency.
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Managing Client Needs and Staffing Rotas 
