• Implementation of a triage score system in an emergency room in Timergara, Pakistan [Short communication]

      Dalwai, M. K; Tayler-Smith, K; Trelles, M; Jemmy, J-P; Maikéré, J; Twomey, M; Wakeel, M; Iqbal, M; Zachariah, R; Médecins Sans Frontières (MSF), Islamabad, Pakistan (International Union Against Tuberculosis and Lung Disease, 2013-03-21)
      Following implementation of the South African Triage Scale (SATS) system in the emergency department (ED) at the District Headquarter Hospital in Timergara, Pakistan, we 1) describe the implementation process, and 2) report on how accurately emergency staff used the system. Of the 370 triage forms evaluated, 320 (86%) were completed without errors, resulting in the correct triage priority being assigned. Fifty completed forms displayed errors, but only 16 (4%) resulted in an incorrect triage priority being assigned. This experience shows that the SATS can be implemented successfully and used accurately by nurses in an ED in Pakistan.
    • Reliability and accuracy of the South African Triage Scale when used by nurses in the emergency department of Timergara Hospital, Pakistan

      Dalwai, M K; Twomey, M; Maikere, J; Said, S; Wakeel, M; Jemmy, J-P; Valles, P; Tayler-Smith, K; Wallis, L; Zachariah, R (Health & Medical Publishing Group, 2014-03)
      Background. Triage is one of the core requirements for the provision of effective emergency care and has been shown to reduce patient mortality. However, in low- and middle-income countries this strategy is underused, under-resourced and poorly researched. Objective. To assess the inter- and intra-rater reliability and accuracy of nurse triage ratings when using the South African Triage Scale (SATS) in an emergency department (ED) in Timergara, Pakistan. Methods. Fifteen ED nurses assigned triage ratings to a set of 42 reference vignettes (written case reports of ED patients) under classroom conditions. Inter-rater reliability was assessed by comparing these triage ratings; intra-rater reliability was assessed by asking the nurses to re-triage 10 random vignettes from the original set of 42 vignettes and comparing these duplicate ratings. Accuracy of the nurse ratings was measured against the reference standard. Results. Inter-rater reliability was substantial (intraclass correlation coefficient 0.77; 95% confidence interval (CI) 0.69 - 0.85). The intra-rater agreement was also high with 87% exact agreement (95% CI 67 - 100) and 100% agreement allowing for a one-level discrepancy in triage ratings. Overall, the SATS had high specificity (97%) and moderate sensitivity (70%). Across all acuity levels the proportion of over-triage did not exceed the acceptable threshold of 30 - 50%. Under-triage was acceptable for all except emergency cases (66%). Conclusion. ED nurses in Pakistan can reliably use the SATS to assign triage acuity ratings. While the tool is accurate for ‘very urgent’ and ‘routine’ cases, importantly, it may under-triage ‘emergency’ cases requiring immediate attention. Approaches that will improve accuracy and validity are discussed.