Evaluate the incidence, topography, management, and outcomes in patients with polytrauma in the Suez Canal and Sinai areas

Introduction: The global prevalence of trauma-related mortality ranges from 2% to 32%; however, In Egypt, it reaches 8%. Trauma chiefly affects people in the productive age group; seriously ill patients with multiple injuries present with various levels of polytrauma. Application of incorrect triage systems and improperly trained trauma teams increase mortality and morbidity rates in non-dedicated institutions; however, these rates can decrease with appropriate infrastructure. This study aimed to improve the quality of care for patients with polytrauma through improved knowledge of the different severity levels of polytrauma and defined databases, using a suitable triage trauma system, well-trained trauma team, and appropriate infrastructure. Methods: This observational cross-sectional study was conducted at the emergency department (ED), over a study period of 7 months, from August 10, 2019, to March 09, 2020. This study included 458 patients with polytrauma who had met the inclusion and exclusion criteria and attended the ED of Suez Canal University Hospital. Results: The incidence of trauma among all emergency cases in the ED was 5.3%. However, most multiple injuries are mild, accounting for 44.4%, while 27.3% of the cases had life-threatening injuries. Moreover, 41.9% of the patients were managed non-operatively, whereas 58.1% of the patients required surgical interventions. Concerning the outcome, 56% and 6.9% of patients with and without life-threatening injuries respectively, died. Conclusion: Facilities of the highest quality should be available for patients with polytrauma, especially those with life-threatening injuries. In addition, training emergency medical service staff for trauma triage is essential, and at least one tertiary hospital is required in every major city in the Suez Canal and Sinai areas to decrease trauma-related mortality.

Evaluation of a modified South African Triage Score as a predictor of patient disposition at a tertiary hospital in Rwanda

Background: Triage is essential for efficient and effective delivery of care in emergency centers (ECs) where numerous patients present simultaneously with varying acuity of conditions. Implementing EC triage systems provides a method of recognizing which patients may require admission and are at higher risks for poor health outcomes. Rwanda is experiencing increased demand for emergency care; however, triage has not been well studied. The University Teaching Hospital of Kigali (UTH-K) is an urban tertiary care health center utilizing a locally modified South African Triage Score (mSATS) that classifies patients into five color categories. Our study evaluated the utility of the mSATS tool at UTH-K. Methods: UTH-K implemented mSATS in April 2013. All patients aged 15 years or older from August 2015 to July 2016 were eligible for inclusion in the database. Variables of interest included demographic information, mSATS category, patient case type (trauma or medical), disposition from the ED and mortality. Results: 1438 cases were randomly sampled; the majority were male (61.9%) and median age was 35 years. Injuries accounted for 56.7% of the cases while medical conditions affected 43.3%. Admission likelihood significantly increased with higher triage color category for medical patients (OR: Yellow=3.61, p<.001 to Red (with alarm)=7.80, p<.01). Likelihood for trauma patients, however, was not significantly increased (OR:Yellow=.84, p=.75 to Red (with alarm)=1.50, p=.65). Mortality rates increased with increasing triage category with the red with alarm category having the highest mortality (7.7%, OR 18.91). Conclusion: The mSATS tool accurately predicted patient disposition and mortality for the overall ED population. The mSATS tool provided useful clinical guidance on the need for hospital admission for medical patients but did not accurately predict patient disposition for injured patients. Further trauma-specific triage studies are needed to improve emergency care in Rwanda

Triage live lecture versus triage video podcast in pre-hospital students' education

Introduction: Triage is the process of determining the priority of patients' treatments based on the severity of their conditions. The aim of the present study was to survey the effect of triage video podcasting on the knowledge and performance of pre-hospital students. Methods: Sixty pre-hospital students were randomly divided into two groups of a 30-subject control group and a 30-subject intervention group. A pre-test was administered among all students. Afterwards, for the first group, triage education was offered through lectures using PowerPoint, while for the second group, audio and video podcasts tailored for this training program were employed. Right after the training as well as one month later, post-tests were run for both groups, and the results were analysed using an independent t-test and covariance.R Results : No significant difference was observed between the effects of both types of education on knowledge and performance, either immediately, or one month after training. Discussion: We suggest that video podcasts are ready to replace traditional teaching methods in triage

Triage conducted by lay-staff and emergency training reduces paediatric mortality in the emergency department of a rural hospital in Northern Mozambique

Introduction The majority of emergency paediatric death in African countries occur within the first 24 h of admission. A coloured triage system is widely implemented in high-income countries and the emergency triage and assessment treatment (ETAT) is recommended by the World Health Organization, but not put into practice in Mozambique. A retrospective, before and after, mortality analysis was performed using routine patient files from the district hospital between 2014 and 2017. The triage system was implemented in August 2016. Inclusion criteria were children under 15 years of age that entered the emergency centre. Primary outcome was child mortality rate. Secondary outcomes included the percentage agreement between the clinical and non-clinical staff and the duration from triage to first treatment. We used a negative binomial model in STATA 15 to compare mortality rates, and Kappa statistics to estimate the agreement between clinical and non-clinical staff. Results : 4176 admissions were included. The mortality rate ratio (MMR) was 45% lower after the start of the intervention (2016; MRR = 0.55; 0.38, 0.81; p = 0.002), compared to before. To estimate the agreement between non-clinical and clinical staff, 548 (of the 671) patient files were included. The agreement was estimated at 88.7% (Kappa = 0.644; p < 0.001). The median waiting time decreased with urgency of the triage: 2 h33 for 'green'/least serious (IQR 1 h58-3 h30), 21 min for yellow/serious (IQR 0 h10-0 h58) and nine minutes for 'red'/urgent (IQR 2­40 min). Conclusion : In a rural setting with nurse-led clinical care and non-clinician staff working at the triage reception, implementation of a three-coloured triage system was feasible. Triage and ETAT training was associated with a decrease of 45% of paediatric deaths. The impact on mortality, low cost, and ease of the implementation supports scaling this intervention in similar settings

COVID-19, disability and the context of healthcare triage in South Africa: Notes in a time of pandemic

During disasters, when resources and care are scarce, healthcare workers are required to make decisions and prioritise which patients receive life-saving resources over others. To assist healthcare workers in standardising resources and care, triage policies have been developed. However, the current COVID-19 triage policies and practices in South Africa may exclude or disadvantage many disabled people, especially people with physical and intellectual impairments, from gaining intensive care unit (ICU) access and receiving ventilators if becoming ill. The exclusion of disabled people goes against the principles established in South Africa's Constitution, in which all people are regarded as equal, have the right to life and inherent dignity, the right to access healthcare, as well as the protection of dignity. In addition, the triage policy contravenes the United Nations Convention on the Rights of Persons with Disabilities, which the South African government has signed and ratified. This article raises debates about whose lives matter and whose lives are 'worth' saving over others, and although the focus is on South Africa, the issues may be relevant to other countries where life-saving resources are being rationed

The accuracy of nurse performance of the triage process in a tertiary hospital emergency department in Gauteng Province, South Africa

Background. Triage in the emergency department (ED) is necessary to prioritise management according to the severity of a patient's condition.The South African Triage Scale (SATS) is a hospital-based triage tool that has been adopted by numerous EDs countrywide.Many factors can influence the outcome of a patient's triage result, and evaluation of performance is therefore pivotal.Objectives. To determine how often patients were allocated to the correct triage category and the extent to which they were incorrectly promoted or demoted, and to determine the main reasons for errors in a nurse-led triage system.Methods. Triage forms from a tertiary hospital ED in Gauteng Province, South Africa, were collected over a 1-week period and reviewed retrospectively.Results. A total of 1 091 triage forms were reviewed. Triage category allocations were correct 68.3% of the time. Of the incorrect category assignments, 44.4% of patients were promoted and 55.6% demoted. Patients in the green category were most commonly promoted (29.4%) and patients who should have been in orange were most commonly demoted (35.0%). Trauma patients were more likely to be incorrectly promoted and non-trauma patients to be incorrectly demoted. Mistakes were mainly due to discriminator errors (57.8%), followed by numerical miscalculations (21.5%). The leading omitted discriminators were 'abdominal pain', 'chest pain' and 'shortness of breath'.Conclusions. Mis-triaging using the SATS can be attributed to incorrect or lack of discriminator use, numerical miscalculations and other human errors. Quality control and quality assurance measures must target training in these areas to minimise mis-triage in the ED

A quality improvement study of the emergency centre triage in a tertiary teaching hospital in northern Ethiopia

Introduction:An effective emergency triage system should prioritize both trauma and non-trauma patients according to level of acuity, while also addressing local disease burden and resource availability.In March 2012, an adapted version of the South African Triage Scale was introduced in the emergency centre (EC) of Ayder Comprehensive Specialized Hospital in northern Ethiopia. Methods:This quality improvement study was conducted to evaluate the implementation of nurse-led emergency triage in a large Ethiopian teaching hospital using the Donabedian model. A 45% random sample was selected from all adult emergency patients during the study period, May 10th to May 25th 2015. Patient charts were collected and retrospectively reviewed. Presence and proper completion of the triage form were appraised. Triage level was abstracted and compared with patient outcome (dichotomized as ''admitted to hospital or died" and ''discharged alive from emergency centre") to quantify over- and under-triage triage. Results: From 251 randomly selected patients, 107 (42.6%) charts were retrieved. From these, only 45/107(42.1%) contained the triage form filled within the chart. None of the triage forms were filled out completely. From 13 (28.9%) admitted or deceased patients, the under-triage rate was 30.7% and from 32(71.1%) patients discharged alive from the EC the over-triage rate was 21.9%. Discussion:The under-triage rate observed in this study exceeds the recommended threshold of 5% and isa serious patient safety concern. However, under-triage may have been magnified by irregularities in the hospital admission process. Haphazard medical record handling, poor documentation, erroneous triage decisions, and poor rapport between nurses and physicians were the main process-related challenges that must be addressed through intensive training and improved human resource management approaches to enhance the quality of triage in the emergency centre

An Evaluation of the Triage Early Warning Score in an Urban Accident and Emergency Department in KwaZulu-Natal

Objective: Triage is an essential first step in the efficient and effective running of any emergency department. A good triage tool saves lives and reduces mortality. The Triage Early Warning Score (TEWS) is a useful tool used to identify patients in emergency departments who are at risk of deterioration and who may require admission. As this triage tool has only been evaluated to a limited extent; this study assessed its effectiveness in identifying patients at risk of early deterioration to enable timely medical intervention.Design and setting: This was a retrospective study of medical records within the accident and emergency department of an urban public hospital. Outcome measures: The calculated TEWS was compared to one of four possible outcomes viz. discharge within 24 hours; admission to the ward; admission to the intensive care unit (ICU); or death in hospital. Pearson's chi-squared tests and cross-tabulation was used to determine the statistical significance of the association. Results: Of the 265 patient records analysed; 233 (87.9) had a TEWS of 7. Of patients with a TEWS of 7; 53.7were discharged; compared to 18.7with a score ? 7; who were discharged. The average score of the four patients who died was 9.5; and 8.2 for the three admitted to ICU. Higher TEWS were significantly associated with increased admission to hospital and in-hospital deaths (p-value 0.032). Conclusion: An effective triage scoring system ensures that those requiring emergency care are appropriately categorised. Prompt intervention will either reverse further physiological decline or facilitate timely referral to the appropriate service level; including ICU

Assessment of knowledge and skills of triage amongst nurses working in the emergency centres in Dar es Salaam, Tanzania

Introduction:The triage nurse in the emergency centre (EC) is the first person that a patient encounters and the triage nurses' knowledge has been cited as an influential factor in triage decision-making. The purpose was to assess the triaging knowledge and skills of nurses working in the ECs in Dar es Salaam; Tanzania.Methods:Both descriptive cross-sectional and observational study designs were used and data was collected using a structured questionnaire; an observation checklist and a triage equipment audit record. The study population was all nurses (enrolled and registered) working within the EC of the national hospital and three municipal district hospitals in Dar es Salaam. Descriptive statistical data analysis was carried out using SPSS 13.0.Results:Thirty three percent (20/60) of the respondents were not knowledgeable about triage. Thirteen percent of the respondents reported that although they had attended workshops; there had been a lack of information on how to triage patients. More than half (52) of the respondents were not able to allocate the patient to the appropriate triage category. Fifty eight percent (35/60) of the respondents had no knowledge on waiting time limits for the triaged categories. Among the four hospitals observed; only one had nurses specifically allocated for patients' triage. The respiratory rate of patients was not assessed by 84 of the triage nurses observed. No pain assessment was done by any of the triage nurses observed. Only one out of four ECs assessed had triage guidelines and triage assessment forms.Discussion:Nurses who participated in this study demonstrated significant deficits in knowledge and skills regarding patients' triaging in the EC. To correct these deficits; immediate in-service training/education workshops should be carried out; followed by continuous professional development on a regular basis; including refresher training; supportive supervision and clinical skills sessions

The implementation of the South African Triage Score (SATS) in an urban teaching hospital, Ghana

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