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

[摘要] Introduction: Over-triage and access-block are worldwide phenomena whichcritically compromise patient care and increase morbidity and mortality. Triage isdesigned to place the patient in the right place at the right time with the rightresources. We sought to determine and evaluate the application reliability of theSouth African Triage Score/Scale (SATS) in adult emergency cases presenting toa central academic hospital and to identify which factors may have influenced this.Methods: Emergency department (ED) triage data for adult patients at a centralacademic hospital in Johannesburg over a seven day period were capturedretrospectively. The investigator applied the SATS 2008 to each triage form.Triage scores and colour banding for the trieur versus the investigator werecompared and the overall degree of triage concordance and discordanceobserved.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 triagebanding assignment revealed rates of concordance of 50.6%, discordance of49.4%, over-triage of 28.5% and under-triage of 20.9%. Tuesday showed thehighest patient load with 21.3% of the weekly total. The mean daily and hourlypatient loads were 285 and 14 respectively. Time of day analysis showed adaytime predominance of 2/3 of total presentations and a peak hour between08h00-09h00.Conclusions: The over-triage (28.5%) rate fell within the American College ofSurgeons Committee on Trauma’s (ACSCOT) accepted rate of 30-50%, whileunder-triage (20.9%) exceeded the accepted ACSCOT levels (<10%). When thetriage score was calculated and recorded there was improved concordance, interraterreliability and reduced over-triage. The discordance levels of over-triagedecreased and under-triage increased respectively with increasing patient acuity.There was no significant correlation between the extent of triage concordance ordiscordance and patient load.

[发布机构] University of the Witwatersrand