Profile and Triage Appropriateness of Trauma Patients Triaged Green: A Prospective Cohort Study from a Secondary Care Hospital in India

Introduction: Triage is an important component of in-hospital trauma care for adequate patient management and to avoid overcrowding in emergency departments (ED). Prioritising the evaluation of non-urgent patients may result in the diversion of workforce from patients requiring immediate care. However, not evaluating these patients may result in missed injuries and poor outcomes. We aimed to evaluate the profile of these non-urgent patients triaged ‘green’, as part of a triage-trial in a secondary-care hospital in India and validate this against the Cape Triage Score (CTS).Methods: We analysed data of patients triaged green in a prospective single-centre cohort study between July 2016 to November 2019. Clinicians at this triage-naive ED were introduced to a triage trial who then assigned a triage category to trauma patients, aged 18 years and above, on initial evaluation. Telephonic follow-up was performed for all patients included in the study. Triage appropriateness was retrospectively analysed using the CTS. Results: We included 4135 trauma patients triaged green. The mean age of patients was 32.8 (±13.1) years, 77% males. The median (IQR) length of stay of admitted patients was 3 (13) days. Half the patients had a mild Injury Severity Score (3-8), with the majority of injuries being blunt (98%). Of the patients triaged green, 97% came in as direct arrivals and 94.4% were discharged from the ED after initial evaluation. As per CTS, nearly three-quarters (74%) of patients were undertriaged ‘green’ by the clinicians in a triage-naive ED. Conclusion: ​​ Three-fourths (74%) of the patients triaged green by clinicians in a secondary care hospital in Mumbai were mistriaged when retrospectively analysed using CTS. This highlights the need for implementation and evaluation of trauma triage training for the in-hospital first responders (clinicians, nurses and other paramedical staff) in the EDs.

The role of triage to reduce waiting times in primary health care facilities in the North West province of South Africa

Background: Worldwide, patients visiting health care facilities in the public health care sector have to wait for attention from health care professionals. In South Africa, the Cape Triage Score system was implemented successfully in hospitals’ emergency departments in the Cape Metropole. The effective utilisation of triage could improve the flow of primary health care (PHC) patients and direct the patients to the right health care professional immediately.Aim: No literature could be traced on the implementation of triage in PHC facilities in South Africa. Consequently, a study addressing this issue could address this lack of information, reduce waiting times in PHC facilities and improve the quality of care.Setting: PHC facilities in a sub-district of the North West province of South Africa.Method: A quantitative, exploratory, typical descriptive pre-test–post-test design was used. The study consisted of two phases. During phase 1, the waiting time survey checklist was used to determine the baseline waiting times. In phase 2, the Cape Triage Score system that triaged the patients and the waiting time survey checklist were used.Results: Data were analysed using Cohen’s effect sizes by comparing the total waiting times obtained in both phases with the waiting time survey checklist. Results indicated no reduction in the overall waiting time; however, there was a practical significance where triage was applied. Referral was much quicker to the correct health professional and to the hospitals.Conclusion: Although the results indicated no reduction in the overall waiting time of patients, structured support systems and triage at PHC facilities should be used to make referral quicker to the correct health professional and to the hospitals.

Nurses' and doctors' perceptions regarding the implementation of a triage system in an emergency unit in South Africa

Triage assessment of patients on arrival at an emergency unit is an essential function in quality emergency care provision, and is a cost-effective and time saving venture. This study investigated nurses’ and doctors’ perceptions about the implementation of the Cape Triage Score in one emergency unit. The challenges encountered prior to the implementation of the Cape Triage Score and the roles and core competencies of the triage nurse were addressed as well as the strengths and weaknesses of the Cape Triage Score. In this descriptive, quantitative and exploratory study, 15 nurses and doctors completed questionnaires. The challenges decreased and the sorting of patients improved after the implementation of the Cape Triage Score. Other strengths of this system included that the triage nurse prioritised patients, as opposed to the receptionist or the administrative staff; and nurses could undertake preliminary investigations without waiting for doctors’ orders to do so. The weaknesses of the implemented Cape Triage Score included that it was not fully functional 100% of the time, and that it was difficult to maintain during peak admission periods due to a shortage of nurses. The recommendations included that management should be convinced of the system’s benefits; nurses should perform the triage function on a rotation basis; more nurses should be available during peak periods; and that the administrative and reception staff should also be orientated about the triage system.OpsommingTriage assessering van pasiënte met hulle aankoms by ‘n ongeluk/noodeenheid is ‘n noodsaaklike funksie van noodsorgvoorsiening, en is ‘n koste-effektiewe en tydbesparende onderneming. Hierdie studie het die persepsies van dokters en verpleegkundiges ondersoek betreffende die implementering van die Cape Triage Score in een noodeenheid. Die uitdagings wat ervaar is voor die implementering van die Cape Triage Score, die rolle en kernvaardighede van die triage verpleegkundige asook die swak en sterk punte van die Cape Triage Score is aangespreek. In hierdie beskrywende, kwantitatiewe en verkennende studie het 15 verpleegkundiges en dokters vraelyste voltooi. Uitdagings het verminder en die prioritisering van die pasiënte het verbeter na die implementering van die Cape Triage Score. Ander sterk punte van die stelsel het ingesluit dat die triage verpleegkundige die pasiënte geprioritiseer het, nie die ontvangsdame of die administratiewe personeel nie, en verpleegkundiges kon voorlopige ondersoeke doen sonder om op doktersbevele te wag. Die swakhede van die geïmplementeerde Cape Triage Score het ingesluit dat dit nog nie ten volle 100% van die tyd gefunksioneer het nie, en dat dit moeilik was om triage gedurende spitstye te handhaaf as gevolg van ‘n tekort aan verpleegkundiges. Die aanbevelings het ingesluit dat bestuur oortuig moet word van die voordele van die stelsel, verpleegkundiges triage funksies op ‘n rotasiebasis moet uitvoer, meer verpleegkundiges beskikbaar moet wees gedurende spitstye; en dat administratiewe en ontvangspersoneel ook georiënteer moet word ten opsigte van die triage stelsel.