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Tiers of Service

The Perinatal Services BC Tiers of Service Framework provides a common language and methodology for defining and planning hospital-based and home birth perinatal services in the province.

The Perinatal Tiers of Service framework was developed by a provincial, multidisciplinary committee which included representation from each of the RHAs and a wide diversity of health care providers providing maternity care (nurses, midwives, general practitioners, obstetricians, perinatologists, pediatricians, and neonatologists) in different care settings (urban, rural, and remote).

While the Tiers of Service provides guidance about the responsibilities, relative capabilities, and resource requirements of each tier of service, RHAs remain accountable for the quality of the services provided. The framework assists RHAs by delineating the responsibilities and requirements at each tier of service.

The framework is not intended to address each and every clinical scenario which may present to a site. Tiers of Service supports system and clinical planning and delivery of appropriate services for the majority of patients receiving care at the site. It does not dictate or define what care can be provided to an individual patient at any given time.

Where a woman's pregnancy or newborn's clinical care becomes complex and a higher-level care is required, it is vital that efficient and safe mechanisms are in place within the existing system to facilitate consultation or referral to a higher level of service. Urgency and escalation to a service that provides a higher level of care must be congruent with the woman's and/or her baby's level of risk. Effective communication and documentation will facilitate continuity of care.

The goal of the framework is to support the development of a coordinated system of health services for pregnant women and their newborns in BC—quality maternal, fetal, and neonatal services in BC that are within a network of care, as close to home, and as safe as possible.

In order to provide a foundation for provincial and health authority planning, the Tiers of Service framework: 

  • provides a common language to streamline planning, coordination, and integration of perinatal services across sectors and geographic boundaries;
  • facilitates a common appreciation of the responsibilities and relative capabilities of each type and tier of service, including academic roles and educational opportunities;
  • supports the availability and allocation of appropriate resources and funding to fulfill those responsibilities;
  • facilitates transfers of patients from one service to another through a common understanding of the relative capabilities and expectations of each service; and
  • facilitates comparisons of regional resource utilization and outcomes.

SOURCE: Tiers of Service ( )
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