The application reliability of the South African triage score in adult emergency cases presenting to a central academic hospital

Hoffman, Deidre Ann
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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.
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