Providing emergency care and assessing a patient triage system in a referral hospital in Somaliland: a cross-sectional study

BMC Health Services Research

Anthony D Harries⁶  Sven Gudmund Hinderaker²  Abdi Yassin⁴  Rony Zachariah⁷  Latifa Ayada³  Reinaldo Gutierrez¹  Pola Valles³  Rafael Van den Bergh⁷  Temmy Sunyoto⁵ 

[1] Médecins Sans Frontières – Operational Centre Brussels, Somaliland Mission, Hargeisa, Somaliland;Centre for International Health, University of Bergen, Bergen, Norway;Médecins Sans Frontières – Operational Centre Brussels, Brussels, Belgium;Ministry of Health, Togdheer Region, Somaliland;Médecins Sans Frontières, Operational Centre Barcelona, Delhi, India;International Union Against Tuberculosis and Lung Disease (The Union), Winchester, UK;Médecins Sans Frontières – Operational Centre Brussels, Operational Research Unit (LuxOR), Luxembourg, Grand Duchy of Luxembourg

关键词: Somaliland;    SATS;    Triage;    Resource-poor;    Emergency care;   

Others  :  1092273
DOI  :  10.1186/s12913-014-0531-3

 received in 2013-07-16, accepted in 2014-10-14,  发布年份 2014

【 摘 要 】

Background

In resource-poor settings, where health systems are frequently stretched to their capacity, access to emergency care is often limited. Triage systems have been proposed as a tool to ensure efficiency and optimal use of emergency resources in such contexts. However, evidence on the practice of emergency care and the implementation of triage systems in such settings, is scarce. This study aimed to assess emergency care provision in the Burao district hospital in Somaliland, including the application of the South African Triage Scale (SATS) tool.

Methods

A cross-sectional descriptive study was undertaken. Routine programme data of all patients presenting at the Emergency Department (ED) of Burao Hospital during its first year of service (January to December 2012) were analysed. The American College of Surgeons Committee on Trauma (ACSCOT) indicators were used as SATS targets for high priority emergency cases (“high acuity” proportion), overtriage and undertriage (with thresholds of >25%, <50% and <10%, respectively).

Results

In 2012, among 7212 patients presented to the ED, 41% were female, and 18% were aged less than five. Only 21% of these patients sought care at the ED within 24 hours of developing symptoms. The high acuity proportion was 22.3%, while the overtriage (40%) and undertriage (9%) rates were below the pre-set thresholds. The overall mortality rate was 1.3% and the abandon rate 2.0%. The outcomes of patients corresponds well with the color code assigned using SATS.

Conclusion

This is the first study assessing the implementation of SATS in a post-conflict and resource-limited African setting showing that most indicators met the expected standards. In particular, specific attention is needed to improve the relatively low rate of true emergency cases, delays in patient presentation and in timely provision of care within the ED. This study also highlights the need for development of emergency care thresholds that are more adapted to resource-poor contexts. These issues are discussed.

【 授权许可】

   
2014 Sunyoto et al.; licensee BioMed Central Ltd.

【 图 表 】

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