https://orcid.org/0000-0003-2168-8476
Dear Editor,
The South African Triage Scale (SATS) consists of the Triage Early Warning Score (TEWS) and the discriminator list. A patient’s vital signs, mobility status, trauma history and level of consciousness are needed to score. The SATS has shown a broad clinical applicability in the literature and is dependent on the correct implementation of the tool. We draw your attention to inconsistencies concerning the validity of red criteria of the South African Triage Scale (SATS) that may provide a new understanding of the validity of SATS in the emergency department (ED).
Meyer et al. concluded that strict waiting time goals may not be achievable in this setting without structural and resource allocation changes, and there may be other reasons for prolonged waiting times.Citation1 They showed that only 49% of patients in the red category (Level 1) were seen within the target time (immediate). It raises serious questions as red patients are in critical condition and easily identifiable from other patients, so there is a general agreement between physicians and nurses to provide care immediately. Over-triage of red patients may, however, also contribute to this delay in the ED. It is possible that only half of red patients are correctly triaged as in reality physicians and nurses do not feel immediate care is always necessary. This finding is congruent with the reported over-triage rate (being placed inappropriately in a category with greater urgency) of 47.8% in the red/orange categories.Citation1
The Trauma Early Warning Score (TEWS) ranges from 0 to 17. Patients with (TEWS) > 7 are assigned to the red category. TEWS is composed of seven items, so even one deviation from the mid-point in all items results in being categorised as red. Therefore, a low threshold for categorisation of red with the TEWS makes SATS as a whole more vulnerable to over-triage. A review of the literature showed 31.9% of red patients suffered from over-triage, which was more than any other SATS category,Citation2 and another study indicated that use of the discriminator list resulted in over-triage in 66.7% of cases.Citation3 It has to be said that over-triage may be a source of disagreement between triage nurses and ED physicians as well as being responsible for a delay in emergency care. Over-triage in the red category may also be responsible for the failure to achieve the waiting time goal. Further revision to adjust the TEWS threshold for the red category is recommended to enhance the validity of SATS.
Kind regards,
ORCID
Mohsen Ebrahimi http://orcid.org/0000-0003-2168-8476
Amir Mirhaghi http://orcid.org/0000-0002-4482-1156
References
- Meyer GD, Meyer TN, Gaunt CB. Validity of the South African triage scale in a rural district hospital. Afr J Emerg Med. 2018 Jul 26;8:145–9. doi:10.1016/j.afjem.2018.07.004.
- Twomey M, Wallis LA, Thompson ML, Myers JE. The South African triage scale (adult version) provides valid acuity ratings when used by doctors and enrolled nursing assistants. Afr J Emerg Med. 2012;2(1):3–12. doi:10.1016/j.afjem.2011.08.014.
- Soogun S, Naidoo M, Naidoo K. An evaluation of the use of the South African triage scale in an urban district hospital in Durban, South Africa. South Afr Family Pract. 2017;59(4):133–7. doi: 10.1080/20786190.2017.1307908