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The South African Triage Scale (SATS)

In 2004, the South African Triage Group (SATG) (formerly known as the Cape Triage Group) was convened under the auspices of the joint Division of Emergency Medicine at the Universities of Cape Town and Stellenbosch.

The aim of the SATG was to produce a triage scale for use throughout South Africa. The group was multi-disciplinary and comprised doctors, nurses and paramedics. The result of the SATG’s activities is the South African Triage Scale (SATS), a physiology and symptom based scale which prioritises into one of five colours and can be used in hospital Emergency Centres as well as in the pre-hospital setting. The SATS has been validated in the public, private health care setting as well as pre-hospital.

Why consider implementing the SATS?

The SATS:

  • has shown to reduce mortality and morbidity
  • is easily taught and understood
  • is practical and user-friendly
  • is reliable and accurate

The benefits of the SATS:

  1. To expedite the delivery of time-critical treatment for patients with life-threatening conditions
  2. To ensure that all people requiring emergency care are appropriately categorized according to their clinical condition
  3. To improve patient flow
  4. To improve patient satisfaction
  5. To decrease the patient’s overall length of stay
  6. To facilitate streaming of less urgent patients
  7. To be user-friendly for all levels of health care professionals.

Resource for download

The Triage Tool

Three versions of the SATS

There are three versions of the SATS, depending on whether the patient is an adult or not. Adults have their own version and this is the one used for examples throughout this training manual. However, children have different values of heart rate, respiratory rate and blood pressure. There are two paediatric versions: one for infants (50cm to 95cm – one week to almost 3 years), and one for children (96cm to 150cm – 3 years to around 12 years). Neonates aged one month or younger should be seen immediately by a doctor.

Two parts to the tool

The SATS consists of 2 parts: the Triage Early Warning Score (TEWS) (part 1) and the discriminator list (part 2).  The discriminator list follows after the TEWS.  The provider needs to calculate the TEWS before moving on to the discriminator list.

1. Triage Early Warning Score (TEWS)

In order to generate a total score, the provider has to observe the basic vital signs of the patient.  Each vital sign monitors a different physiological system:

  • Blood pressure and Heart rate monitor the cardiovascular system (heart and blood flow).  You as the provider are interested in the systolic value only.  That is the top value of the blood pressure (BP=120/80, systolic BP or SBP=120)
  • Respiratory rate monitors the respiratory system (lungs)
  • Temperature monitors thermoregulatory system (infections, hypothermia)
  • AVPU monitors the central nervous system (brain)
  • Mobility monitors the musculoskeletal system (bones and muscles)
  • Trauma refers to the presence of ANY injury (bump, bruise, cut etc)

By comparing the observed basic vitals of the patient with a parameter on the TEWS calculator (horizontally) a score can be read off (vertically).  These scores are added together which gives the provider a total TEWS.

2. Discriminator list

The second part or the discriminator list is the part that generates the actual triage colour (red, orange, yellow, green, blue) which will determine urgency level and essentially also when the patient will be attended to. As with the TEWS, there are separate versions of this for infants, children and adults respectively.

The TEWS will only identify and classify a patient into an appropriate triage code if the physiology of the patient is altered from normal.  The TEWS will be effective for most of the cases presenting to the triage provider.

There are however some discriminators that require special attention.  It has been found that physiology alone does not pick up and classify patients with these discriminators safely and effectively.  These discriminators therefore serve as a safety net for those patients with severe enough pathology to be seen more urgently, but who’s physiology did not respond to the insult and therefore did not generate an a urgency appropriate TEWS.  They are reclassified after the TEWS has been calculated

The Stepwise Approach

The  Stepwise flowchart poster shows how simple it is to calculate the triage code for a patient by simply following the stepwise approach.  This approach allows the triage provider to code patients both effectively and safely in the minimum time period.  Triage providers should always use this approach unless directed otherwise by a senior health care professional.

Triage Interventions and Management Aids

Management of the patient starts when the triage provider’s analysis starts.  It is therefore critical that this management continues after the triage process has been completed.The table below indicates the appropriate management of the different triage categories by the triage provider.

COLOUR Management
RED Refer to the resuscitation room for emergency management
ORANGE Refer to the anteroom for urgent management
YELLOW Refer to the anteroom for management
GREEN Patient for potential streaming
BLUE Refer to doctor for certification

It is also possible for the triage provider to commence management when treatment is readily available and the provider’s registration / qualification allows the intervention.  Appropriate interventions directed at observed abnormalities during triage decreases the patient’s morbidity and increases patient satisfaction.

A triage provider may also, time permitting, use triage aids to enhance the triage sensitivity.  Triage aids will assist the senior health care professional later; after the patient has been referred according to the criteria set in table 10 above.  Triage aids (compulsory) should be performed, time permitting, whenever available but is not essential for the triage itself.  The triage interventions and management aids poster indicates appropriate interventions that must be commenced by the triage provider as well as triage aids that can be used to enhance the triage process.

Links to the following for further resources and discussion:

For further information on:

  • train the trainer courses and accreditation
  • customized implementation packages
  • support with triage improvement projects
  • developing triage standard operating procedures
  • additional training resources

CONTACT US:

satriage@webmail.co.za

michele@emssa.org.za

PHOTO GALLERY

SATS training material

Emergency Centre waiting area

Triage room

Triage room with SATS posters displayed

Height markings displayed on wall for quick reference

Quick height measure to determine appropriate SATS poster

Triage in action