An assessment of nurse-led triage at Connaught Hospital, Sierra Leone in the immediate post-Ebola period

Abstract

Introduction: Nurse-led triage, using the South African Triage Scale, was introduced to the emergency centre of the tertiary referral hospital in Freetown, Sierra Leone in early 2014 prior to the Ebola epidemic. The aim of this study was to measure the effectiveness of the process now that the country has been declared free of Ebola. Methods: The study was conducted over a five-day consecutive period in the adult emergency centre of the main government teaching hospital in December 2015. The times from arrival to triage and medical assessment were recorded and compared for each triage category. We also assessed the inter-rater reliability of the process. Results: 111 patients were included during the study period. In terms of acuity, 6% were categorised as red, 27% were orange, 20% yellow and 47% green. Triage Early Warning Score was correctly calculated in 90% of cases and there was inter-rater agreement of colour code and triage category on 92% of occasions (k = 0.877, p < 0.001). Median time from triage to assessment was 15 min for red patients, 20 min for orange, 40 min for yellow and 72 min for green. Discussion: The triage process is functioning effectively in the emergency centre after the Ebola epidemic and provides a reliable assessment of undifferentiated patients presenting to the hospital to ensure that they are seen in a timely manner based on acuity.