The application reliability of the South African triage score in adult emergency cases presenting to a central academic hospital
Date
2014
Authors
Hoffman, Deidre Ann
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Abstract
Introduction: Over-triage and access-block are worldwide phenomena which
critically compromise patient care and increase morbidity and mortality. Triage is
designed to place the patient in the right place at the right time with the right
resources. We sought to determine and evaluate the application reliability of the
South African Triage Score/Scale (SATS) in adult emergency cases presenting to
a central academic hospital and to identify which factors may have influenced this.
Methods: Emergency department (ED) triage data for adult patients at a central
academic hospital in Johannesburg over a seven day period were captured
retrospectively. The investigator applied the SATS 2008 to each triage form.
Triage scores and colour banding for the trieur versus the investigator were
compared and the overall degree of triage concordance and discordance
observed.
Results: A total sample size of 1758 cases was recorded. Moderate agreement
(quadratically weighted 0.524 at 95%CI 0.450-0.598) for the overall triage
banding assignment revealed rates of concordance of 50.6%, discordance of
49.4%, over-triage of 28.5% and under-triage of 20.9%. Tuesday showed the
highest patient load with 21.3% of the weekly total. The mean daily and hourly
patient loads were 285 and 14 respectively. Time of day analysis showed a
daytime predominance of 2/3 of total presentations and a peak hour between
08h00-09h00.
Conclusions: The over-triage (28.5%) rate fell within the American College of
Surgeons Committee on Trauma’s (ACSCOT) accepted rate of 30-50%, while
under-triage (20.9%) exceeded the accepted ACSCOT levels (<10%). When the
triage score was calculated and recorded there was improved concordance, interrater
reliability and reduced over-triage. The discordance levels of over-triage
decreased and under-triage increased respectively with increasing patient acuity.
There was no significant correlation between the extent of triage concordance or
discordance and patient load.
Description
A research report submitted to the Faculty of Health Sciences, University of the
Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the
degree of Master of Medicine (MMed) in the Division of Emergency Medicine.
Johannesburg, 2014