Effective triage in the Pacific region: The development and implementation of the Solomon Islands Triage Scale

Lynne E. Wanefalea, Rob Mitchell, Trina Sale, Elizabeth Sanau, Georgina A. Phillips

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Objective: The ED at the National Referral Hospital in Honiara, Solomon Islands, receives approximately 50 000 patients per year. A 2014 review of ED functioning identified deficiencies in triage processes. Placement of Australian volunteer advisors provided an opportunity to develop and implement a purpose-designed triage system. Methods: Action research methodology and the ‘plan, act, observe, reflect’ cycle was employed, leading to the development of a three-tier triage system based on the South African Triage Scale. ED patient flow and data management processes were simultaneously updated, and staff were trained in the new system. After a pilot period, the Solomon Islands Triage Scale was implemented in August 2017. Evaluation after 3 months of operation included predictive validity (using admission and case fatality rates as surrogate markers of urgency) and reliability (based on inter-rater agreement at retrospective chart review by an independent nurse). Results: In the period 1 August to 31 October, there were 10 905 presentations, of which 97.1% were allocated a triage category (1% category 1, 21.3% category 2 and the remainder category 3). Admission rates correlated closely with triage category (P < 0.01). The case fatality rate was 22.1% for category 1 patients, 0.09% for category 2 and 0.01% for category 3 (P < 0.01). An audit of 96 records conducted in October 2017 revealed 88.4% agreement for triage category allocation. Conclusion: Solomon Islands Triage Scale is the first three-tier triage scale to be implemented in the Pacific region and appears to have adequate validity and reliability. The partnership between Australian volunteers and local clinicians is a positive example of capacity development and represents a model that could be implemented in other resource-limited settings.

Original languageEnglish
JournalEMA - Emergency Medicine Australasia
DOIs
Publication statusAccepted/In press - 1 Jan 2019

Keywords

  • emergency
  • Pacific
  • triage

Cite this

@article{6b4ed3972686496a93522c00f2df1ac7,
title = "Effective triage in the Pacific region: The development and implementation of the Solomon Islands Triage Scale",
abstract = "Objective: The ED at the National Referral Hospital in Honiara, Solomon Islands, receives approximately 50 000 patients per year. A 2014 review of ED functioning identified deficiencies in triage processes. Placement of Australian volunteer advisors provided an opportunity to develop and implement a purpose-designed triage system. Methods: Action research methodology and the ‘plan, act, observe, reflect’ cycle was employed, leading to the development of a three-tier triage system based on the South African Triage Scale. ED patient flow and data management processes were simultaneously updated, and staff were trained in the new system. After a pilot period, the Solomon Islands Triage Scale was implemented in August 2017. Evaluation after 3 months of operation included predictive validity (using admission and case fatality rates as surrogate markers of urgency) and reliability (based on inter-rater agreement at retrospective chart review by an independent nurse). Results: In the period 1 August to 31 October, there were 10 905 presentations, of which 97.1{\%} were allocated a triage category (1{\%} category 1, 21.3{\%} category 2 and the remainder category 3). Admission rates correlated closely with triage category (P < 0.01). The case fatality rate was 22.1{\%} for category 1 patients, 0.09{\%} for category 2 and 0.01{\%} for category 3 (P < 0.01). An audit of 96 records conducted in October 2017 revealed 88.4{\%} agreement for triage category allocation. Conclusion: Solomon Islands Triage Scale is the first three-tier triage scale to be implemented in the Pacific region and appears to have adequate validity and reliability. The partnership between Australian volunteers and local clinicians is a positive example of capacity development and represents a model that could be implemented in other resource-limited settings.",
keywords = "emergency, Pacific, triage",
author = "Wanefalea, {Lynne E.} and Rob Mitchell and Trina Sale and Elizabeth Sanau and Phillips, {Georgina A.}",
year = "2019",
month = "1",
day = "1",
doi = "10.1111/1742-6723.13248",
language = "English",
journal = "EMA - Emergency Medicine Australasia",
issn = "1742-6731",
publisher = "Wiley-Blackwell",

}

Effective triage in the Pacific region : The development and implementation of the Solomon Islands Triage Scale. / Wanefalea, Lynne E.; Mitchell, Rob; Sale, Trina; Sanau, Elizabeth; Phillips, Georgina A.

In: EMA - Emergency Medicine Australasia, 01.01.2019.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Effective triage in the Pacific region

T2 - The development and implementation of the Solomon Islands Triage Scale

AU - Wanefalea, Lynne E.

AU - Mitchell, Rob

AU - Sale, Trina

AU - Sanau, Elizabeth

AU - Phillips, Georgina A.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Objective: The ED at the National Referral Hospital in Honiara, Solomon Islands, receives approximately 50 000 patients per year. A 2014 review of ED functioning identified deficiencies in triage processes. Placement of Australian volunteer advisors provided an opportunity to develop and implement a purpose-designed triage system. Methods: Action research methodology and the ‘plan, act, observe, reflect’ cycle was employed, leading to the development of a three-tier triage system based on the South African Triage Scale. ED patient flow and data management processes were simultaneously updated, and staff were trained in the new system. After a pilot period, the Solomon Islands Triage Scale was implemented in August 2017. Evaluation after 3 months of operation included predictive validity (using admission and case fatality rates as surrogate markers of urgency) and reliability (based on inter-rater agreement at retrospective chart review by an independent nurse). Results: In the period 1 August to 31 October, there were 10 905 presentations, of which 97.1% were allocated a triage category (1% category 1, 21.3% category 2 and the remainder category 3). Admission rates correlated closely with triage category (P < 0.01). The case fatality rate was 22.1% for category 1 patients, 0.09% for category 2 and 0.01% for category 3 (P < 0.01). An audit of 96 records conducted in October 2017 revealed 88.4% agreement for triage category allocation. Conclusion: Solomon Islands Triage Scale is the first three-tier triage scale to be implemented in the Pacific region and appears to have adequate validity and reliability. The partnership between Australian volunteers and local clinicians is a positive example of capacity development and represents a model that could be implemented in other resource-limited settings.

AB - Objective: The ED at the National Referral Hospital in Honiara, Solomon Islands, receives approximately 50 000 patients per year. A 2014 review of ED functioning identified deficiencies in triage processes. Placement of Australian volunteer advisors provided an opportunity to develop and implement a purpose-designed triage system. Methods: Action research methodology and the ‘plan, act, observe, reflect’ cycle was employed, leading to the development of a three-tier triage system based on the South African Triage Scale. ED patient flow and data management processes were simultaneously updated, and staff were trained in the new system. After a pilot period, the Solomon Islands Triage Scale was implemented in August 2017. Evaluation after 3 months of operation included predictive validity (using admission and case fatality rates as surrogate markers of urgency) and reliability (based on inter-rater agreement at retrospective chart review by an independent nurse). Results: In the period 1 August to 31 October, there were 10 905 presentations, of which 97.1% were allocated a triage category (1% category 1, 21.3% category 2 and the remainder category 3). Admission rates correlated closely with triage category (P < 0.01). The case fatality rate was 22.1% for category 1 patients, 0.09% for category 2 and 0.01% for category 3 (P < 0.01). An audit of 96 records conducted in October 2017 revealed 88.4% agreement for triage category allocation. Conclusion: Solomon Islands Triage Scale is the first three-tier triage scale to be implemented in the Pacific region and appears to have adequate validity and reliability. The partnership between Australian volunteers and local clinicians is a positive example of capacity development and represents a model that could be implemented in other resource-limited settings.

KW - emergency

KW - Pacific

KW - triage

UR - http://www.scopus.com/inward/record.url?scp=85062935850&partnerID=8YFLogxK

U2 - 10.1111/1742-6723.13248

DO - 10.1111/1742-6723.13248

M3 - Article

JO - EMA - Emergency Medicine Australasia

JF - EMA - Emergency Medicine Australasia

SN - 1742-6731

ER -