Effectiveness of the South African Triage Scale in improving patient outcomes: a qualitative exploration of Ghanian nurses' experiences

Abstract

Background: Effective triage systems are essential for optimal emergency care delivery, yet remain underutilized in resource-limited African settings. The South African Triage Scale (SATS) was designed specifically for such environments. This study evaluates emergency nurses' perceptions of SATS effectiveness in improving patient outcomes and emergency department (ED) efficiency at Cape Coast Teaching Hospital, Ghana. Methods: A qualitative exploratory descriptive study was conducted with 14 emergency nurses (ages 28-55 years) through four focus group discussions in May 2023. Semi-structured interviews explored nurses' experiences with SATS implementation, utilizing thematic content analysis. Participants had 3-20 years of nursing experience and received formal SATS training. Results: Two major themes were identified aligned with study objectives: effectiveness of SATS tool and impact of SATS training. Under SATS effectiveness, three sub-themes emerged: improved patient outcomes, ethical dilemmas, and Triage Early Warning Score (TEWS) score interpretation challenges. Nurses perceived SATS implementation as significantly improving patient outcomes through objective acuity assessment and systematic prioritization. Participants reported perceptions of reduced waiting times for critically ill patients, decreased mortality rates, and enhanced resource allocation. The tool enabled prompt identification of red-category (emergent) patients requiring immediate intervention. Key success factors included bi-annual training workshops, standardized triage protocols, and the SATS discriminator list facilitating rapid clinical decision-making. However, challenges included ethical dilemmas in balancing autonomy with urgency, equipment reliability issues, and nurses' concerns regarding TEWS score parameters for certain vital sign presentations. Conclusion: Emergency nurses perceived SATS as successfully implementable in resource-limited African settings, reporting improvements in ED efficiency and patient outcomes. The standardized approach enhanced clinical decision-making and optimized resource utilization despite infrastructural constraints. Further education on evidence-based vital sign interpretation may enhance protocol adherence.