title: Reduced overtriage and undertriage with a new triage system in an urban accident and emergency department in Botswana: a cohort study.
abstract: BACKGROUND
  Improvements in triage have demonstrated improved clinical outcomes in resource-limited settings. In 2009, the Accident and Emergency (A&E) Department at the Princess Marina Hospital (PMH) in Botswana identified the need for a more objective triage system and adapted the South African Triage Scale to create the PMH A&E Triage Scale (PATS).
  
  
  OBJECTIVE
  The primary purpose was to compare the undertriage and overtriage rates in the PATS and pre-PATS study periods.
  
  
  METHODS
  Data were collected from 5 April 2010 to 1 May 2011 for the PATS and compared with a database of patients triaged from 1 October 2009 to 24 March 2010 for the pre-PATS. Data included patient disposition outcomes, demographics and triage level assignments.
  
  
  RESULTS
  14 706 (pre-PATS) and 25 243 (PATS) patient visits were reviewed. Overall, overtriage rates improved from 53% (pre-PATS) to 38% (PATS) (p<0.001); likewise, undertriage rates improved from 47% (pre-PATS) to 16% (PATS) (p<0.001). Statistically significant decreases in both rates were found when paediatric and adult cases were analysed separately. PATS was more predictive of inpatient admission, Intensive Care Unit (ICU) admission and death rates in the A&E than was the pre-PATS. The lowest acuity category of each system had a 0.6% (pre-PATS) and 0% (PATS) chance of death in the A&E or ICU admission (p<0.001). No change in death rate was seen between the pre-PATS and PATS, but ICU admission rates decreased from 0.35% to 0.06% (p<0.001).
  
  
  CONCLUSIONS
  PATS is a more predictive triage system than pre-PATS as evidenced by improved overtriage, undertriage and patient severity predictability across triage levels.
authors: Division of Emergency Medicine, Children's National Medical Center, George Washington University, Washington, DC, USA.
authors: Paul C
authors: PC
authors: Mullan
authors: Division of Pediatric Emergency Medicine, Department of Emergency Medicine, New York University School of Medicine, New York, New York, USA.
authors: Susan B
authors: SB
authors: Torrey
authors: Department of Emergency Medicine, University of Botswana School of Medicine, Gaborone, Botswana.
authors: Amit
authors: A
authors: Chandra
authors: Department of Emergency Medicine, University of Botswana School of Medicine, Gaborone, Botswana.
authors: Ngaire
authors: N
authors: Caruso
authors: Department of Emergency Medicine, University of British Columbia and St. Paul's Hospital, Vancouver, British Columbia, Canada.
authors: Andrew
authors: A
authors: Kestler
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001902:Botswana; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006760:Hospitalization; D006786:Hospitals, Urban; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D062072:Patient Acuity; D014218:Triage / Q000458:organization & administration*; D055815:Young Adult
keywords: emergency department; triage