An assessment of nurse-led triage at Connaught Hospital, Sierra Leone in the immediate post-Ebola period

Lowsby, Richard; Kamara, Cecilia; Kamara, Michael; Nyhus, Hedda Bøe; Williams, Nathaniel; Bradfield, Michael; Harrison, Hooi-Ling

doi:10.1016/j.afjem.2016.10.003

Cited by 9 publications

(14 citation statements)

References 9 publications

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“…In Sierra Leone, the SATS proved a reliable tool that also led to improvements in waiting times for high acuity patients. 13 Similarly, in Somaliland 12 and rural South Africa, 14 the SATS demonstrated feasibility as well as sound predictive validity. A recent review of the SATS in non-African settings found a significant correlation between triage category, admission rate and mortality, similar to the findings in the present study.…”

Section: Discussionmentioning

confidence: 89%

“…The findings of the present study are broadly consistent with the experience of other resource‐limited ED that have recently implemented triage scales. In Sierra Leone, the SATS proved a reliable tool that also led to improvements in waiting times for high acuity patients . Similarly, in Somaliland and rural South Africa, the SATS demonstrated feasibility as well as sound predictive validity.…”

Section: Discussionmentioning

confidence: 94%

“…The most widely studied is the South African Triage Scale (SATS), which has shown acceptable validity and reliability in several settings. [10][11][12][13][14][15][16][17] One Malawian study has demonstrated that training staff in emergency skills, introducing triage and improving patient flow can reduce mortality rates and increase efficiency. 18 Although this data is not definitive, it suggests that implementation of triage systems in RLEs has the potential to improve clinical outcomes as well as ED functioning.…”

Section: Triage In Developing Settingsmentioning

confidence: 99%

“…A number of triage scales have been developed for resource‐limited environments (RLEs). The most widely studied is the South African Triage Scale (SATS), which has shown acceptable validity and reliability in several settings . One Malawian study has demonstrated that training staff in emergency skills, introducing triage and improving patient flow can reduce mortality rates and increase efficiency .…”

Section: Introductionmentioning

confidence: 99%

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Effective triage in the Pacific region: The development and implementation of the Solomon Islands Triage Scale

Wanefalea

Mitchell

Sale³

et al. 2019

Emerg Medicine Australasia

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Objective The ED at the National Referral Hospital in Honiara, Solomon Islands, receives approximately 50 000 patients per year. A 2014 review of ED functioning identified deficiencies in triage processes. Placement of Australian volunteer advisors provided an opportunity to develop and implement a purpose‐designed triage system. Methods Action research methodology and the ‘plan, act, observe, reflect’ cycle was employed, leading to the development of a three‐tier triage system based on the South African Triage Scale. ED patient flow and data management processes were simultaneously updated, and staff were trained in the new system. After a pilot period, the Solomon Islands Triage Scale was implemented in August 2017. Evaluation after 3 months of operation included predictive validity (using admission and case fatality rates as surrogate markers of urgency) and reliability (based on inter‐rater agreement at retrospective chart review by an independent nurse). Results In the period 1 August to 31 October, there were 10 905 presentations, of which 97.1% were allocated a triage category (1% category 1, 21.3% category 2 and the remainder category 3). Admission rates correlated closely with triage category (P < 0.01). The case fatality rate was 22.1% for category 1 patients, 0.09% for category 2 and 0.01% for category 3 (P < 0.01). An audit of 96 records conducted in October 2017 revealed 88.4% agreement for triage category allocation. Conclusion Solomon Islands Triage Scale is the first three‐tier triage scale to be implemented in the Pacific region and appears to have adequate validity and reliability. The partnership between Australian volunteers and local clinicians is a positive example of capacity development and represents a model that could be implemented in other resource‐limited settings.

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Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 94%

Section: Triage In Developing Settingsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Effective triage in the Pacific region: The development and implementation of the Solomon Islands Triage Scale

Wanefalea

Mitchell

Sale³

et al. 2019

Emerg Medicine Australasia

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“…All patients presenting to the AaBET Hospital emergency department (ED) pass through a single point of triage, where trained emergency triage nurses record essential clinical and demographic information and assign a triage acuity designation according to the South African Triage Scale (SATS) [ 9 ]. The SATS has been validated for use in diverse low-income urban adult and pediatric ED settings, [ 10 – 13 ] and has high reported inter-rater reliability among emergency nurses (ĸ = 0.92), [ 14 , 15 ] and in trauma settings [ 16 ]. It is currently used in all public EDs in Addis Ababa.…”

Section: Methodsmentioning

confidence: 99%

Ambulance use is not associated with patient acuity after road traffic collisions: a cross-sectional study from Addis Ababa, Ethiopia

et al. 2018

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BackgroundAfrica accounts for one sixth of global road traffic deaths—most in the pre-hospital setting. Ambulance transport is expensive relative to other modes of pre-hospital transport, but has advantages in time-sensitive, high-acuity scenarios. Many countries, including Ethiopia, are expanding ambulance fleets, but clinical characteristics of patients using ambulances remain ill-defined.MethodsThis is a cross-sectional study of 662 road traffic collisions (RTC) patients arriving to a single trauma referral center in Addis Ababa, Ethiopia, over 7 months. Emergency Department triage records were used to abstract clinical and arrival characteristics, including acuity. The outcome of interest was ambulance arrival. Secondary outcomes of interest were inter-facility referral and referral communication. Descriptive and multivariable statistics were computed to identify factors independently associated with outcomes.ResultsOver half of patients arrived with either high (13.1%) or moderate (42.2%) acuity. Over half (59.0%) arrived by ambulance, and nearly two thirds (65.9%) were referred. Among referred patients, inter-facility communication was poor (57.7%). Patients with high acuity were most likely to be referred (aOR 2.20, 95%CI 1.16–4.17), but were not more likely to receive ambulance transport (aOR 1.56, 95%CI 0.86–2.84) or inter-facility referral communication (aOR 0.98, 95%CI 0.49–1.94) than those with low acuity. Nearly half (40.2%) of all patients were referred by ambulance despite having low acuity.ConclusionsDespite ambulance expansion in Addis Ababa, ambulance use among RTC patients remains heavily concentrated among those with low-acuity. Inter-facility referral appears a primary contributor to low-acuity ambulance use. In other contexts, similar routine ambulance monitoring may help identify low-value utilization. Regional guidelines may help direct ambulance use where most valuable, and warrant further evaluation.Electronic supplementary materialThe online version of this article (10.1186/s12873-018-0158-5) contains supplementary material, which is available to authorized users.

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Implementation of a novel three-tier triage tool in Papua New Guinea: A model for resource-limited emergency departments

Mitchell

McKup

Bue

et al. 2020

The Lancet Regional Health - Western Pacific

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In emergency departments (EDs), demand for care often exceeds the available resources. Triage addresses this problem by sorting patients into categories of urgency. The Interagency Integrated Triage Tool (IITT) is a novel triage system designed for resource-limited emergency care (EC) settings. The system was piloted by two EDs in Papua New Guinea as part of an EC capacity development program. Implementation involved a five-hour teaching program for all ED staff, complemented by training resources including flowcharts and reference guides. Clinical redesign helped optimise flow and infrastructure, and development of simple electronic registries enabled data collection. Local champions were identified, and experienced EC clinicians from Australia acted as mentors during system roll-out. Evaluation data suggests the IITT, and the associated change management process, have high levels of acceptance amongst staff. Subject to validation, the IITT may be relevant to other resource-limited EC settings.

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An assessment of nurse-led triage at Connaught Hospital, Sierra Leone in the immediate post-Ebola period

Cited by 9 publications

References 9 publications

Effective triage in the Pacific region: The development and implementation of the Solomon Islands Triage Scale

Effective triage in the Pacific region: The development and implementation of the Solomon Islands Triage Scale

Ambulance use is not associated with patient acuity after road traffic collisions: a cross-sectional study from Addis Ababa, Ethiopia

Implementation of a novel three-tier triage tool in Papua New Guinea: A model for resource-limited emergency departments

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