Reliability and accuracy of the South African Triage Scale when used by nurses in the emergency department of Timergara Hospital, Pakistan

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dc.contributor.authorDalwai, Mohammed Khan
dc.contributor.authorTwomey, Michèle
dc.contributor.authorMaïkéré, Jacob
dc.contributor.authorSaid, Shujaat
dc.contributor.authorWakeel, Muhammed
dc.contributor.authorJemmy, Jean-Paul
dc.contributor.authorValles, Pola
dc.contributor.authorTayler-Smith, Katie
dc.contributor.authorWallis, Lee
dc.contributor.authorZachariah, Rony
dc.date.accessioned2021-10-08T07:20:29Z
dc.date.available2021-10-08T07:20:29Z
dc.date.issued2014
dc.description.abstractBACKGROUND: Triage is one of the core requirements for the provision of effective emergency care and has been shown to reduce patient mortality. However, in low- and middle-income countries this strategy is underused, under-resourced and poorly researched. OBJECTIVE: To assess the inter- and intra-rater reliability and accuracy of nurse triage ratings when using the South African Triage Scale (SATS) in an emergency department (ED) in Timergara, Pakistan. METHODS: Fifteen ED nurses assigned triage ratings to a set of 42 reference vignettes (written case reports of ED patients) under classroom conditions. Inter-rater reliability was assessed by comparing these triage ratings; intra-rater reliability was assessed by asking the nurses to re-triage 10 random vignettes from the original set of 42 vignettes and comparing these duplicate ratings. Accuracy of the nurse ratings was measured against the reference standard. RESULTS: Inter-rater reliability was substantial (intraclass correlation coefficient 0.77; 95% confidence interval (CI) 0.69 - 0.85). The intra-rater agreement was also high with 87% exact agreement (95% CI 67 - 100) and 100% agreement allowing for a one-level discrepancy in triage ratings. Overall, the SATS had high specificity (97%) and moderate sensitivity (70%). Across all acuity levels the proportion of over-triage did not exceed the acceptable threshold of 30 - 50%. Under-triage was acceptable for all except emergency cases (66%). CONCLUSION: ED nurses in Pakistan can reliably use the SATS to assign triage acuity ratings. While the tool is accurate for 'very urgent' and 'routine' cases, importantly, it may under-triage 'emergency' cases requiring immediate attention. Approaches that will improve accuracy and validity are discussed.
dc.identifier.apacitationDalwai, M. K., Twomey, M., Maïkéré, J., Said, S., Wakeel, M., Jemmy, J., ... Zachariah, R. (2014). Reliability and accuracy of the South African Triage Scale when used by nurses in the emergency department of Timergara Hospital, Pakistan. <i>South African Medical Journal</i>, 104(5), 372 - 177. http://hdl.handle.net/11427/34930en_ZA
dc.identifier.chicagocitationDalwai, Mohammed Khan, Michèle Twomey, Jacob Maïkéré, Shujaat Said, Muhammed Wakeel, Jean-Paul Jemmy, Pola Valles, Katie Tayler-Smith, Lee Wallis, and Rony Zachariah "Reliability and accuracy of the South African Triage Scale when used by nurses in the emergency department of Timergara Hospital, Pakistan." <i>South African Medical Journal</i> 104, 5. (2014): 372 - 177. http://hdl.handle.net/11427/34930en_ZA
dc.identifier.citationDalwai, M.K., Twomey, M., Maïkéré, J., Said, S., Wakeel, M., Jemmy, J., Valles, P. & Tayler-Smith, K. et al. 2014. Reliability and accuracy of the South African Triage Scale when used by nurses in the emergency department of Timergara Hospital, Pakistan. <i>South African Medical Journal.</i> 104(5):372 - 177. http://hdl.handle.net/11427/34930en_ZA
dc.identifier.issn0038-2469
dc.identifier.ris TY - Journal Article AU - Dalwai, Mohammed Khan AU - Twomey, Michèle AU - Maïkéré, Jacob AU - Said, Shujaat AU - Wakeel, Muhammed AU - Jemmy, Jean-Paul AU - Valles, Pola AU - Tayler-Smith, Katie AU - Wallis, Lee AU - Zachariah, Rony AB - BACKGROUND: Triage is one of the core requirements for the provision of effective emergency care and has been shown to reduce patient mortality. However, in low- and middle-income countries this strategy is underused, under-resourced and poorly researched. OBJECTIVE: To assess the inter- and intra-rater reliability and accuracy of nurse triage ratings when using the South African Triage Scale (SATS) in an emergency department (ED) in Timergara, Pakistan. METHODS: Fifteen ED nurses assigned triage ratings to a set of 42 reference vignettes (written case reports of ED patients) under classroom conditions. Inter-rater reliability was assessed by comparing these triage ratings; intra-rater reliability was assessed by asking the nurses to re-triage 10 random vignettes from the original set of 42 vignettes and comparing these duplicate ratings. Accuracy of the nurse ratings was measured against the reference standard. RESULTS: Inter-rater reliability was substantial (intraclass correlation coefficient 0.77; 95% confidence interval (CI) 0.69 - 0.85). The intra-rater agreement was also high with 87% exact agreement (95% CI 67 - 100) and 100% agreement allowing for a one-level discrepancy in triage ratings. Overall, the SATS had high specificity (97%) and moderate sensitivity (70%). Across all acuity levels the proportion of over-triage did not exceed the acceptable threshold of 30 - 50%. Under-triage was acceptable for all except emergency cases (66%). CONCLUSION: ED nurses in Pakistan can reliably use the SATS to assign triage acuity ratings. While the tool is accurate for 'very urgent' and 'routine' cases, importantly, it may under-triage 'emergency' cases requiring immediate attention. Approaches that will improve accuracy and validity are discussed. DA - 2014 DB - OpenUCT DP - University of Cape Town IS - 5 J1 - South African Medical Journal LK - https://open.uct.ac.za PY - 2014 SM - 0038-2469 T1 - Reliability and accuracy of the South African Triage Scale when used by nurses in the emergency department of Timergara Hospital, Pakistan TI - Reliability and accuracy of the South African Triage Scale when used by nurses in the emergency department of Timergara Hospital, Pakistan UR - http://hdl.handle.net/11427/34930 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/34930
dc.identifier.vancouvercitationDalwai MK, Twomey M, Maïkéré J, Said S, Wakeel M, Jemmy J, et al. Reliability and accuracy of the South African Triage Scale when used by nurses in the emergency department of Timergara Hospital, Pakistan. South African Medical Journal. 2014;104(5):372 - 177. http://hdl.handle.net/11427/34930.en_ZA
dc.language.isoeng
dc.publisher.departmentDivision of Emergency Medicine
dc.publisher.facultyFaculty of Health Sciences
dc.sourceSouth African Medical Journal
dc.source.journalissue5
dc.source.journalvolume104
dc.source.pagination372 - 177
dc.source.urihttps://dx.doi.org/10.7196/SAMJ.7604
dc.subject.otherCross-Sectional Studies
dc.subject.otherEmergency Nursing
dc.subject.otherEmergency Service, Hospital
dc.subject.otherHospitals
dc.subject.otherHumans
dc.subject.otherObserver Variation
dc.subject.otherPakistan
dc.subject.otherReproducibility of Results
dc.subject.otherSouth Africa
dc.subject.otherTriage
dc.titleReliability and accuracy of the South African Triage Scale when used by nurses in the emergency department of Timergara Hospital, Pakistan
dc.typeJournal Article
uct.type.publicationResearch
uct.type.resourceJournal Article
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