The accuracy of nurse-led triage of adult patients in the emergency centre of urban private hospitals

Abstract

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), discriminator 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.