IntroductionThe implementation of a triage system is a vital step in improving the functioning and patient flow of the emergency centre in a rural district hospital. The South African Triage Scale (SATS) is a well validated and reliable tool used widely in South Africa and other low- and middle-income countries. This study aims to assess the validity of the SATS in a rural district hospital context.MethodsThis is a cross-sectional study. All patients presenting to the Zithulele Hospital emergency centre from 1 October 2015 to 31 December 2015 were triaged using the SATS system, routinely collected data was used to determine the correlation between assigned acuity and outcome to determine rates of under- and over-triage. Patient demographics were collected and waiting times were compared to existing standards of the SATS tool.ResultsOf the 4002 patients presenting to the emergency centre during the study period, 2% were triaged as emergency patients, 15% as very urgent, 38% as urgent and 45% as routine. The assigned acuities correlate well with outcome (f = 0.37; p < 0.0001) and an acceptable rate of over-triage (49%) and under-triage (9%) was found. Waiting time targets were poorly achieved with only 49% of emergency, 23% very urgent, 46% urgent and 69% routine patients seen within ideal target times.DiscussionThe SATS is a valid tool to implement in a rural district emergency centre. Strict waiting time goals may not be achievable in this setting without structural and resource allocation changes to allow for improvements in the surge capacity of staff to manage urgent and emergency patients.

Introduction This case report discusses the successful use of an improvised bubble continuous positive airway pressure (CPAP) apparatus made using items commonly available in a poorly resourced district hospital. Case presentation A 64-year-old female with no co-morbidities presented with respiratory failure due to pulmonary tuberculosis and was not accepted into the regional Intensive Care Unit (ICU) on referral. She required 8 days of improvised bubble CPAP to maintain adequate oxygen saturation before weaning and eventual discharge. Discussion Improvised bubble CPAP is commonly used in neonatal care in developing countries and well described in literature however, there are no reports of its successful use in adult patients. In the absence of access to ICU or other Non-invasive ventilation (NIV) equipment, improvised bubble CPAP may provide some therapeutic benefit.

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