Comparison of the novel WEst coast System for Triage (WEST) with Rapid Emergency Triage and Treatment System (RETTS©): an observational pilot study

Abstract

Background Most Swedish emergency departments (ED) use the triage system Rapid Emergency Triage and Treatment System (RETTS©), which over time has proven to prioritize patients to higher triage levels. When many patients are prioritized to high triage levels, challenges with identifying true high-risk patients and increased waiting time for these patients has emerged. In order to achieve a more balanced triage in relation to actual medical risk, the triage system WEst coast System for Triage (WEST) was developed, based on the South African Triage Scale (SATS). The aim of this study was to perform an initial evaluation of the novel emergency triage system WEST compared to the existing RETTS©. Methods Both RETTS© and WEST are five level triage systems illustrated by colors. Nurses from each of the three adult EDs of Sahlgrenska University Hospital in Gothenburg and the ambulance service assessed and triaged 1510 patients according to RETTS© and immediately thereafter filled out the WEST triage form. Data from each triage report were analyzed and grouped according to the triage color, chief complaint, and outcome of each patient. Data on discharge categories and events within 72 h were also collected. Data were analyzed with descriptive statistical methods. Results In general, WEST displayed lower levels of prioritization compared to RETTS©, with no observed impact on patients’ medical outcomes. In RETTS© orange triage level, approximately 50% of the patients were down prioritized in WEST to yellow or green triage levels. Also, in the RETTS© yellow triage level, more than 55% were down prioritized to green triage level in WEST. The number of patients who experienced a serious event during the first 72 h was few. Three patients died, these were all prioritized to red triage level in RETTS©. In WEST two of these patients were prioritized to red triage level and one to orange triage level. All these patients were admitted to hospital before deterioration. Conclusions WEST may reduce over prioritization at the ED, especially in the orange and yellow triage levels of RETTS©, with no observed increase in medical risk. WEST can be recommended for a clinical comparative study.

A low proportion of undertriage validates the new West coast system for triage—Paediatric

“…To address the problem with overtriage, a new triage system was developed at the PED of the Sahlgrenska University Hospital: the West Coast System for Triage—Paediatric (WEST‐P). A similar project for adult triage (WEST‐A) was launched in 2018 at the adult emergency department at Sahlgrenska University Hospital 9 . Both projects were inspired by the Paediatric and Adult South African Triage Scale 10…”

Evaluation of the implementation process of a new emergency triage system, WEst coast System for Triage (WEST)

“…Based on the observed increase in patients being triaged at the orange level, a hospital in Western Sweden initiated a review of their triage procedures. This prompted the creation of the WEst coast System for Triage (WEST), inspired by the South African Triage Scale [12]. Initial assessments of SATS-based systems indicated enhanced prioritization accuracy [13], leading to the initial implementation of WEST in two EDs.…”

Emergency Department Triage in Sweden: Occurrence, Validity, Reliability and Registered Nurses' Experiences

“…Furthermore, a study around a novel Swedish ED triage system was recently published. The WEst coast System for Triage (WEST) is developed in the same region as METTS and RETTS© were and it is based on SATS (192). This development may indicate that ED triage in Sweden is experiencing a dynamic phase to which this thesis can contribute to in-depth understanding and evidence-based knowledge.…”