Jurnal Internasional vol.12 issue 2 2022
African Journal of Emergency Medicine
The accuracy of nurse-led triage of adult patients in the emergency centre of urban private hospitals

Jurnal Internasional vol.12 issue 2 2022
African Journal of Emergency Medicine
The accuracy of nurse-led triage of adult patients in the emergency centre of urban private hospitals

Accuracy
Emergency centre
Nurses
South African triage scale
Triage

Background: Triage is applied in emergency centres (ECs) to assign degrees of urgency to illnesses or injuries
to decide in which order to treat patients, especially when there are many patients or casualties, facilitating the
allocation of scarce medical resources. A triage nurse determines triage priority by assessing patients using an
established triage tool with specific criteria. The South African Triage Scale is widely used in South African ECs.
Although the South African Triage Scale has been adopted and implemented in both private and public healthcare
ECs in South Africa, few studies have assessed the accuracy of nurse-led triage in private ECs.
Aim: To determine the accuracy of nurse-led triage in ECs in urban, private hospitals.
Methods: A quantitative, descriptive, retrospective study was done. Three private hospitals with similar average
patient volumes were purposively selected. We sampled the nursing notes as follows: 1) we stratified nursing
notes by nurse qualification and then 2) for each category of nurse we stratified nursing notes according to triage
priority level and 3) then systematically randomly selected the recommended number of notes from each triage
priority level for each nurse category. We retrospectively audited 389 EC nursing notes to determine the accuracy
of nurse-led triage. For each note, we independently applied the South African Triage Scale, and then determined
agreement between our score and the score determined by the triage nurse.

Results: We recorded 342 triage errors, consisting of triage early warning scores (TEWS) errors (n = 168), dis-
criminator errors (n = 97) and additional investigation errors (n = 77). Overall agreement between the triage

nurses and our scores was 71.7% (n = 279). Triage errors (n = 110) consisted of 3.9% (n = 15) over-triage errors
and 24.4% (n = 95) under-triage errors. The highest level of agreement was between our scores and the scores
of the emergency trained registered nurses (85%) and enrolled nursing assistants (78%).
Conclusion: In South African ECs, the South African Triage Scale is not always correctly applied, which can lead
to almost a quarter (24.4%) of cases being under-triaged and not receiving timeous care. Our results suggest that
emergency trained registered nurses are well equipped to be triage nurses, and that this skill should be developed
in South African nursing curricula.

Jenna Smith∗

, Celia Filmalter, Andries Masenge, Tanya Heyns

https://doi.org/10.1016/j.afjem.2022.02.007

23 February 2022

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