The implementation of the South African Triage Score (SATS) in an urban teaching hospital, Ghana

Abstract

Introduction Triage is the process of sorting patients based on the level of acuity to ensure the most severely injured and ill patients receive timely care before their condition worsens. The South African Triage Scale (SATS) was developed out of a need for an accurate and objective measure of urgency based on physiological parameters and clinical discriminators that is easily implemented in low resource settings. SATS was introduced in the emergency center (EC) of Komfo Anokye Teaching Hospital (KATH) in January 2010. This study seeks to evaluate the accurate use of the SATS by nurses at KATH. Methods This cross-sectional study was conducted in the EC at KATH in Kumasi, Ghana. Patients 12 years and over with complete triage information were included in this study. Each component of SATS was calculated (i.e. for heart rate of 41–50, a score of 1 was given) and summed. This score was compared to the original triage score. When scores did not equate, the entire triage record was reviewed by an emergency physician and an advanced practice emergency nurse separately to determine if the triage was appropriate. These reviews were compared and consensus reached. Results 52 of 903 adult patients (5.8%) were judged to have been mis-triaged by expert review; 49 under-triaged (sent to a zone that corresponded to a lower acuity level than they should have been, based on their vital signs) and 3 over-triaged. Of the 49 patients who were under-triaged, 34 were under-triaged by one category and 7 by two categories. Conclusion Under-triage is a concern to patient care and safety, and while the under-triage rate of 5.7% in this sample falls within the 5–10% range considered unavoidable by the American College of Surgeons Committee on Trauma, concentrated efforts to regularly train triage nurses to ensure no patients are under-triaged have been undertaken. Overall though, SATS has been implemented successfully in the EC at KATH by triage nurses.

Cardiopulmonary ultrasound for critically ill adults improves diagnostic accuracy in a resource‐limited setting: the AFRICA trial

“…Upon arrival at the KATH ED, patients are triaged using the South African Triage Score, a scoring system developed in South Africa and since validated in various resource‐limited settings. This ‘triage score’ is generated based on the patient's mobility, respiratory rate, heart rate, systolic blood pressure, temperature, AVPU (alert/verbal/pain/unresponsive) score and trauma . Patients with more abnormal values for these criteria receive a higher triage score.…”

Effective triage in the Pacific region: The development and implementation of the Solomon Islands Triage Scale

“…The most widely studied is the South African Triage Scale (SATS), which has shown acceptable validity and reliability in several settings. [10][11][12][13][14][15][16][17] One Malawian study has demonstrated that training staff in emergency skills, introducing triage and improving patient flow can reduce mortality rates and increase efficiency. 18 Although this data is not definitive, it suggests that implementation of triage systems in RLEs has the potential to improve clinical outcomes as well as ED functioning.…”

“…A number of triage scales have been developed for resource‐limited environments (RLEs). The most widely studied is the South African Triage Scale (SATS), which has shown acceptable validity and reliability in several settings . One Malawian study has demonstrated that training staff in emergency skills, introducing triage and improving patient flow can reduce mortality rates and increase efficiency .…”

An evaluation of the use of the South African Triage Scale in an urban district hospital in Durban, South Africa

“…Previous studies that support and validate the use of the SATS were conducted mainly in large secondary-and tertiary-level hospitals situated in either urban or rural parts of South Africa. 1,[11][12][13] These hospitals are often better staffed and equipped than district hospitals. A previous audit on the use of SATS in the National District Hospital in Bloemfontein concluded that the tool was poorly implemented.…”