ABSTRACT
Introduction: African emergency medical services (EMS) systems are inadequate, thereby necessitating its selective use. This study aims to investigate differences in mode of arrival to the Emergency Centre (EC) at Komfo Anokye Teaching Hospital in Kumasi, Ghana by acuity, injury and referral status. Methods: A cross-sectional survey was conducted in the EC at the Komfo Anokye Teaching Hospital (KATH) in Kumasi, Ghana, in 2011. A survey was administered to all patients triaged to the EC. Patients were excluded if they were under 18 years of age, unable to communicate in English, Twi, or Fante, had altered mental status, or were deceased. Data were inputted into an excel spread sheet and uploaded to SPSS. Descriptive statistics were computed. Inferential statistics were performed testing for differences and associations between modes of arrival and acuity level, referral and injury status.Results: Of the 1004 patients enrolled, 411 (41%) had an injury-related complaint, and 458 (45.6%) were inter-facility transfers (''referrals''). 148 (14.8%) arrived by ambulance, and 778 (77.6%) non-ambulance (38% private cars, 38% taxis). 67 (6.7%) were triaged as Red, 276 (27.5%) as Orange, and 637 (63.4%) as Yellow (highest to lowest acuity). Ambulance arrival was positively associated with a higher triage score (OR: 1.53). Patients referred from other facilities were almost twice as likely (OR 1.92) to arrive at the KATH EC via ambulance than those not referred. Patients with injuries and higher acuities patients were more likely to be transported to KATH by ambulance (OR 1.86 and 1.87 respectively). All results are highly statistically significant. Conclusion: Although a minority of patients were transported by ambulance, they represented the most acute patients arriving at the KATH EC. Given the limited availability of EMS resources and ambulances in Ashanti, selective ambulance use appears warranted and should inform prehospital care planning
Subject(s)
Ambulances , Automobile Driving , Emergency Medical Services , Ghana , Hospitals, TeachingABSTRACT
Introduction:Triage is the process of sorting patients based on the level of acuity to ensure the most severely injured and ill patients receive timely care before their condition worsens. The South African Triage Scale (SATS) was developed out of a need for an accurate and objective measure of urgency based on physiological parameters and clinical discriminators that is easily implemented in low resource settings. SATS was introduced in the emergency center (EC) of Komfo Anokye Teaching Hospital (KATH) in January 2010. This study seeks to evaluate the accurate use of the SATS by nurses at KATH.Methods:This cross-sectional study was conducted in the EC at KATH in Kumasi; Ghana. Patients 12years and over with complete triage information were included in this study. Each component of SATS was calculated (i.e. for heart rate of 41-50; a score of 1 was given) and summed. This score was compared to the original triage score. When scores did not equate; the entire triage record was reviewed by an emergency physician and an advanced practice emergency nurse separately to determine if the triage was appropriate. These reviews were compared and consensus reached. Results :52 of 903 adult patients (5.8) were judged to have been mis-triaged by expert review; 49 under-triaged (sent to a zone that corresponded to a lower acuity level than they should have been; based on their vital signs) and 3 over-triaged. Of the 49 patients who were under-triaged; 34 were under-triaged by one category and 7 by two categories.Conclusion:Under-triage is a concern to patient care and safety; and while the under-triage rate of 5.7 in this sample falls within the 5-10 range considered unavoidable by the American College of Surgeons Committee on Trauma; concentrated efforts to regularly train triage nurses to ensure no patients are under-triaged have been undertaken. Overall though; SATS has been implemented successfully in the EC at KATH by triage nurses