Rouhani Shada A, Aaronson Emily, Jacques Angella, Brice Sandy, Marsh Regan H
Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, United States; Department of Emergency Medicine, Harvard Medical School, Boston, MA, United States; University Teaching Hospital at Mirebalais, Mirebalais, Haiti; Partners In Health, Boston, MA, United States.
Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, United States; Department of Emergency Medicine, Harvard Medical School, Boston, MA, United States.
Int Emerg Nurs. 2017 Jul;33:26-31. doi: 10.1016/j.ienj.2016.12.004. Epub 2017 Feb 20.
Effective triage is an important part of high quality emergency care, yet is frequently lacking in resource-limited settings. The South African Triage Scale (SATS) is designed for these settings and consists of a numeric score (triage early warning score, TEWS) and a list of clinical signs (known as discriminators). Our objective was to evaluate the implementation of SATS at a new teaching hospital in Haiti.
A random sample of emergency department charts from October 2013 were retrospectively reviewed for the completeness and accuracy of the triage form, correct calculation of the triage score, and final patient disposition. Over and under triage were calculated. Comparisons were evaluated with chi-squared analysis.
Of 390 charts were reviewed, 385 contained a triage form and were included in subsequent analysis. The final triage color was recorded for 68.4% of patients, clinical discriminators for 48.6%, and numeric score for 96.1%. The numeric score was calculated correctly 78.3% of the time; in 13.2% of patients a calculation error was made that would have changed triage priority. In 23% of cases, chart review identified clinical discriminators should have been circled but were not recorded. Overtriage and undertriage were 75.6% and 7.4% respectively.
This study demonstrates that with limited structured training, SATS was widely adopted, but the clinical discriminators were used less commonly than the numeric score. This should be considered in future implementations of SATS.
有效的分诊是高质量急诊护理的重要组成部分，但在资源有限的环境中常常缺乏。南非分诊量表（SATS）专为这些环境设计，由一个数字评分（分诊早期预警评分，TEWS）和一系列临床体征（称为鉴别指标）组成。我们的目的是评估SATS在海地一家新建教学医院的实施情况。
对2013年10月急诊科病历的随机样本进行回顾性审查，以检查分诊表格的完整性和准确性、分诊评分的正确计算以及患者的最终处置情况。计算过度分诊和分诊不足的情况。采用卡方分析进行比较评估。
在审查的390份病历中，385份包含分诊表格并纳入后续分析。68.4%的患者记录了最终分诊颜色，48.6%记录了临床鉴别指标，96.1%记录了数字评分。数字评分正确计算的时间占78.3%；13.2%的患者存在计算错误，这可能会改变分诊优先级。在23%的病例中，病历审查发现临床鉴别指标应被圈出但未记录。过度分诊和分诊不足分别为75.6%和7.4%。
本研究表明，在结构化培训有限的情况下，SATS被广泛采用，但临床鉴别指标的使用不如数字评分普遍。在未来实施SATS时应考虑这一点。
