Implementation and performance of the South African Triage Scale at Kenyatta National Hospital in Nairobi, Kenya
Abstract Introduction Triage 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. Objectives We so...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2019-02-01
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| Series: | International Journal of Emergency Medicine |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12245-019-0221-3 |
| _version_ | 1818304569079234560 |
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| author | Ali A. Wangara Katherine M. Hunold Sarah Leeper Frederick Ndiawo Judith Mweu Shaun Harty Rachael Fuchs Ian B. K. Martin Karen Ekernas Stephen J. Dunlop Michèle Twomey Alice W. Maingi Justin Guy Myers |
| author_facet | Ali A. Wangara Katherine M. Hunold Sarah Leeper Frederick Ndiawo Judith Mweu Shaun Harty Rachael Fuchs Ian B. K. Martin Karen Ekernas Stephen J. Dunlop Michèle Twomey Alice W. Maingi Justin Guy Myers |
| author_sort | Ali A. Wangara |
| collection | DOAJ |
| description | Abstract Introduction Triage 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. Objectives We 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. Methods Part 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. Results Healthcare 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. Conclusion Healthcare 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. |
| first_indexed | 2024-12-13T06:12:46Z |
| format | Article |
| id | doaj.art-06080eefb12c40e1a995c1d91e7168d4 |
| institution | Directory Open Access Journal |
| issn | 1865-1372 1865-1380 |
| language | English |
| last_indexed | 2024-12-13T06:12:46Z |
| publishDate | 2019-02-01 |
| publisher | BMC |
| record_format | Article |
| series | International Journal of Emergency Medicine |
| spelling | doaj.art-06080eefb12c40e1a995c1d91e7168d42022-12-21T23:57:02ZengBMCInternational Journal of Emergency Medicine1865-13721865-13802019-02-011211810.1186/s12245-019-0221-3Implementation and performance of the South African Triage Scale at Kenyatta National Hospital in Nairobi, KenyaAli A. Wangara0Katherine M. Hunold1Sarah Leeper2Frederick Ndiawo3Judith Mweu4Shaun Harty5Rachael Fuchs6Ian B. K. Martin7Karen Ekernas8Stephen J. Dunlop9Michèle Twomey10Alice W. Maingi11Justin Guy Myers12Accident and Emergency Department, Kenyatta National HospitalDepartment of Emergency Medicine, The Ohio State UniversityDepartment of Emergency Medicine, University of Maryland Prince George’s Hospital CenterAccident and Emergency Department, Kenyatta National HospitalCritical Care Unit, Kenyatta National HospitalDepartment of Emergency Medicine, The University of CincinnatiDepartment of Biostatistics, FHI 360 & UNC Gillings School of Global Public HealthDepartment of Emergency Medicine, Medical College of WisconsinDepartment of Emergency Medicine, St. Joseph HospitalDepartment of Emergency Medicine, Hennepin County Medical CenterUniversity HospitalAccident and Emergency Department, Kenyatta National HospitalDepartment of Emergency Medicine, University of North Carolina at Chapel Hill School of MedicineAbstract Introduction Triage 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. Objectives We 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. Methods Part 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. Results Healthcare 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. Conclusion Healthcare 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.http://link.springer.com/article/10.1186/s12245-019-0221-3Accident and emergency medicineTriageEast Africa |
| spellingShingle | Ali A. Wangara Katherine M. Hunold Sarah Leeper Frederick Ndiawo Judith Mweu Shaun Harty Rachael Fuchs Ian B. K. Martin Karen Ekernas Stephen J. Dunlop Michèle Twomey Alice W. Maingi Justin Guy Myers Implementation and performance of the South African Triage Scale at Kenyatta National Hospital in Nairobi, Kenya International Journal of Emergency Medicine Accident and emergency medicine Triage East Africa |
| title | Implementation and performance of the South African Triage Scale at Kenyatta National Hospital in Nairobi, Kenya |
| title_full | Implementation and performance of the South African Triage Scale at Kenyatta National Hospital in Nairobi, Kenya |
| title_fullStr | Implementation and performance of the South African Triage Scale at Kenyatta National Hospital in Nairobi, Kenya |
| title_full_unstemmed | Implementation and performance of the South African Triage Scale at Kenyatta National Hospital in Nairobi, Kenya |
| title_short | Implementation and performance of the South African Triage Scale at Kenyatta National Hospital in Nairobi, Kenya |
| title_sort | implementation and performance of the south african triage scale at kenyatta national hospital in nairobi kenya |
| topic | Accident and emergency medicine Triage East Africa |
| url | http://link.springer.com/article/10.1186/s12245-019-0221-3 |
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