Triage capabilities of medical trainees in Ghana using the South African triage scale: an opportunity to improve emergency care

Abstract

IntroductionThe incidence of emergency conditions is increasing worldwide, particularly in low- and middle-income countries (LMICs). However, triage and emergency care training has not been prioritized in LMICs. We aimed to assess the reliability and validity of the South African Triage Scale (SATS) when used by providers not specifically trained in SATS, as well as to compare triage capabilities between senior medical students and senior house officers to examine the effectiveness of our curriculum for house officer training with regards to triage.MethodsSixty each of senior medical students and senior house officers who had not undergone specific triage or SATS training were asked to triage 25 previously validated emergency vignettes using the SATS. Estimates of reliability and validity were calculated. Additionally, over- and under-triage, as well as triage performance between the medical students and house officers was assessed against a reference standard.ResultsFifty-nine senior medical students (98% response rate) and 43 senior house officers (72% response rate) completed the survey (84% response rate overall). A total of 2,550 triage assignments were included in the analysis (59 medical student and 43 house officer triage assignments for 25 vignettes each; 1,475 and 1,075 triage assignments, respectively). Inter-rater reliability was moderate (quadratically weighted κ 0.59 and 0.60 for medical students and house officers, respectively). Triage using SATS performed by these groups had low sensitivity (medical students: 54%, 95% CI 49–59; house officers: 55%, 95% CI 48–60) and moderate specificity (medical students: 84%, 95% CI 82 - 89; house officers: 84%, 95% CI 82 - 97). Both groups under-triaged most ‘emergency’ level vignette patients (i.e. SATS Red; 80 and 82% for medical students and house officers, respectively). There was no difference between the groups for any metric.ConclusionAlthough the SATS has proven utility in a number of different settings in LMICs, its success relies on its use by trained providers. Given the large and growing burden of emergency conditions, training current and future emergency care providers in triage is imperative.

Characterising emergency centre encounters in Mbour, Senegal as emergent-emergency care, emergent-primary care or non-emergent

“…In comparison to Mbour, several other African countries are moving towards using the South African Triage Scale (SATS), which has been found to be an adaptable triage protocol in LMICs [20] . SATS does not rely on computer-based medical records, and has been found to be successful in low resource settings when users are properly trained [21] .…”

Inter-rater and intrarater reliability of the South African Triage Scale in low-resource settings of Haiti and Afghanistan

“…Two articles assessing reliability in South Africa report moderate to substantial reliability with QWK of 0.57 and 0.66, respectively. 14 15 In Ghana, the SATS showed moderate reliability with QWK of 0.59 and 0.60 16 while studies in Pakistan and Botswana reported substantial to near-perfect results with QWK of 0.77 and 0.87, respectively. 8 9 In high-resource settings, the Canadian Emergency Department Triage and Acuity Scale (CTAS), a 5-level triage scale, reported a chance corrected kappa of 0.80 and a weighted kappa of 0.77.…”

A descriptive study of trauma cases encountered in the Grand M’Bour Hospital Emergency Department in Senegal

“…Additionally, low-and middle-income community hospitals should implement a systematic triage system to insure their limited human and physical emergency resource capacity is being utilized for appropriate patients, which can help decrease the time a critical patient is waiting to be treated by provider. The South African Triage Scale (SATS), developed in 2004, has proven to be a reliable and validated tool that has been implemented in various western African countries, including Ghana [15]. The SATS divides patients into five different urgency categories based on a brief clinical assessment of a patient, with each category indicating how quickly a physician should see them [16].…”

“…The SATS divides patients into five different urgency categories based on a brief clinical assessment of a patient, with each category indicating how quickly a physician should see them [16]. Implementation of SATS, along with training in EM, has shown to reduce wasting of medical resources and reduce morbidity and mortality in patients [15]. This study was not without limitations.…”