Implementation and performance of the South African Triage Scale at Kenyatta National Hospital in Nairobi, Kenya

International Journal of Emergency Medicine

  ^{1    2    2    2    3    4    5    6    7    8    9    1,10    1,11} 

[1] 0000 0000 9206 4546, grid.414021.2, Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN, USA;0000 0001 0626 737X, grid.415162.5, Accident and Emergency Department, Kenyatta National Hospital, PO Box 3956-00200, Nairobi, Kenya;0000 0001 0626 737X, grid.415162.5, Critical Care Unit, Kenyatta National Hospital, Nairobi, Kenya;0000 0001 2111 8460, grid.30760.32, Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI, USA;0000 0001 2179 9593, grid.24827.3b, Department of Emergency Medicine, The University of Cincinnati, Cincinnati, OH, USA;0000 0001 2285 7943, grid.261331.4, Department of Emergency Medicine, The Ohio State University, Columbus, OH, USA;0000 0004 0438 0290, grid.415189.0, Department of Emergency Medicine, University of Maryland Prince George’s Hospital Center, Maryland, MD, USA;0000 0004 0441 7452, grid.414672.2, Department of Emergency Medicine, St. Joseph Hospital, Denver, CO, USA;0000000122483208, grid.10698.36, Department of Biostatistics, FHI 360 & UNC Gillings School of Global Public Health, Chapel Hill, NC, USA;0000000122483208, grid.10698.36, Department of Emergency Medicine, University of North Carolina at Chapel Hill School of Medicine, 170 Manning Drive, CB 7594, 27599, Chapel Hill, NC, USA;University Hospital, Bern, Switzerland;

关键词: Accident and emergency medicine;    Triage;    East Africa;   

DOI  :  10.1186/s12245-019-0221-3

来源: publisher

【 摘 要 】

IntroductionTriage protocols standardize and improve patient care in accident and emergency departments (A&Es). Kenyatta National Hospital (KNH), the largest public tertiary hospital in East Africa, is resource-limited and was without A&E-specific triage protocols.ObjectivesWe sought to standardize patient triage through implementation of the South African Triage Scale (SATS). We aimed to (1) assess the reliability of triage decisions among A&E healthcare workers following an educational intervention and (2) analyze the validity of the SATS in KNH’s A&E.MethodsPart 1 was a prospective, before and after trial utilizing an educational intervention and assessing triage reliability using previously validated vignettes administered to 166 healthcare workers. Part 2 was a triage chart review wherein we assessed the validity of the SATS in predicting patient disposition outcomes by inclusion of 2420 charts through retrospective, systematic sampling.ResultsHealthcare workers agreed with an expert defined triage standard for 64% of triage scenarios following an educational intervention, and had a 97% agreement allowing for a one-level discrepancy in the SATS score. There was “good” inter-rater agreement based on an intraclass correlation coefficient and quadratic weighted kappa. We analyzed 1209 pre-SATS and 1211 post-SATS patient charts and found a non-significant difference in undertriage and statistically significant decrease in overtriage rates between the pre- and post-SATS cohorts (undertriage 3.8 and 7.8%, respectively, p = 0.2; overtriage 70.9 and 62.3%, respectively, p < 0.05). The SATS had a sensitivity of 92.2% and specificity of 37.7% for predicting admission, death, or discharge in the A&E.ConclusionHealthcare worker triage decisions using the SATS were more consistent with expert opinion following an educational intervention. The SATS also performed well in predicting outcomes with high sensitivity and satisfactory levels of both undertriage and overtriage, confirming the SATS as a contextually appropriate triage system at a major East African A&E.

【 授权许可】

CC BY