Abstract
BackgroundIn resource-poor settings, where health systems are frequently stretched to their capacity, access to emergency care is often limited. Triage systems have been proposed as a tool to ensure efficiency and optimal use of emergency resources in such contexts. However, evidence on the practice of emergency care and the implementation of triage systems in such settings, is scarce. This study aimed to assess emergency care provision in the Burao district hospital in Somaliland, including the application of the South African Triage Scale (SATS) tool.MethodsA cross-sectional descriptive study was undertaken. Routine programme data of all patients presenting at the Emergency Department (ED) of Burao Hospital during its first year of service (January to December 2012) were analysed. The American College of Surgeons Committee on Trauma (ACSCOT) indicators were used as SATS targets for high priority emergency cases (“high acuity” proportion), overtriage and undertriage (with thresholds of >25%, <50% and <10%, respectively).ResultsIn 2012, among 7212 patients presented to the ED, 41% were female, and 18% were aged less than five. Only 21% of these patients sought care at the ED within 24 hours of developing symptoms. The high acuity proportion was 22.3%, while the overtriage (40%) and undertriage (9%) rates were below the pre-set thresholds. The overall mortality rate was 1.3% and the abandon rate 2.0%. The outcomes of patients corresponds well with the color code assigned using SATS.ConclusionThis is the first study assessing the implementation of SATS in a post-conflict and resource-limited African setting showing that most indicators met the expected standards. In particular, specific attention is needed to improve the relatively low rate of true emergency cases, delays in patient presentation and in timely provision of care within the ED. This study also highlights the need for development of emergency care thresholds that are more adapted to resource-poor contexts. These issues are discussed.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-014-0531-3) contains supplementary material, which is available to authorized users.
Highlights
In resource-poor settings, where health systems are frequently stretched to their capacity, access to emergency care is often limited
Patients for whom the target time to treat was not met were at increased risk of death, with a Relative Risk of 2.2 when compared with all patients treated within time, the difference was not significant when stratified for South African Triage Scale (SATS) score
This study demonstrates the feasibility of providing emergency care, including implementation of the new SATS triage system in Burao General Hospital, Somaliland
Summary
In resource-poor settings, where health systems are frequently stretched to their capacity, access to emergency care is often limited. Triage systems have been proposed as a tool to ensure efficiency and optimal use of emergency resources in such contexts. This study aimed to assess emergency care provision in the Burao district hospital in Somaliland, including the application of the South African Triage Scale (SATS) tool. One approach to reducing the strain on overburdened emergency services is the use of a proper emergency triage tool, which is intended to ensure that patients receive the most appropriate level and quality of care relative to their clinical status and need, ensuring optimal use of clinicians’ time and resources. The South African Triage Scale (SATS) is such a tool This was developed for use used by non-specialist (nursing) staff to identify patients at higher risk of death, and to enhance ED efficiency [6]. In the centres where it has been evaluated – such as urban and rural centres in South Africa, where it was developed [6,7], and elsewhere [8] – it has been associated with positive outcomes such as reductions in waiting time, length of stay, and mortality [9], and, at the same time, improvement of the patient flow
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