Setting up a triage 101

by King’s volunteer Mike Bradfield

Prior to last week, Connaught had no functioning triage  – a system used in the Accident and Emergency ward to determine the priority of patients’ treatments based on the severity of their condition. Setting up a triage is a major project of the Connaught Hospital Improvement Committee and King’s has been working with key staff from across the hospital and the Ministry to lay the foundations for this project. My background as a paramedic has (hopefully) placed me in a good position to work with hospital staff to prepare for its launch and help it get off the ground.

We decided to start with a pilot to allow us to resolve any issues before the wider training and implementation takes place. In preparing for the pilot we identified four nursing staff recommended by A&E Matron Kamara. It was also decided that it might be worth checking with these staff that they actually wanted to do this, but following a brief meeting with Dr Ahmed and I, all seemed to have a firm grasp of what triage would involve and supported the idea. It was encouraging to see how much enthusiasm there was for change and improvement. So far, so good.

The South African Triage Scale (SATS) tool appeared to be relatively straightforward (note to self, no triage system is straightforward), and with a day assigned for teaching later in the week a training package was put together, handouts printed and a plan for the day written. Anxious to avoid death by PowerPoint, the training included a walk-around of the new triage area of the hospital and some discussions around the practicalities of how the new system would work.  We also wanted as much input from the nursing staff as possible and for them to be involved in decisions around the way it would be used. It seemed important to spend time ensuring staff have a good understanding of the rationale for triage and its importance at Connaught rather than focus only on the minute details.  But we still needed to cover how the SATS tool functions. Let’s be honest, it isn’t really first date material, however enthusiastic we all are about it.

In a warm room with no air conditioning, an hour session was extended to several due to a large number of questions and discussions.  In a bid to liven things up, we recruited Senior Nurse Nyama to role-play a difficult patient wanting to know why she was not being seen in turn.  Nurse Salamata was far better able to explain the triage system than I had been able to that morning and Nurse Hajara faced down any criticism of the system with a very succinct and direct summary of the reasons for waiting (which would be used by her again the following week to excellent effect).  It was beginning to feel that with this level of engagement and enthusiasm, we could make this work.

With the training started, the building work complete and the Facilities and Maintenance staff (Willie and Abdul, you know who you are, even if we rarely know where you are) working very hard to repair and clean the necessary equipment and areas, 3rd March was confirmed as a start date for the triage pilot. The Friday before the Monday that the pilot was due to start, we had very little equipment but we did have a desk. And we had a lot of phone calls and many more promises of equipment to be delivered yesterday. The list was not long, but it was important. Given that we had no blood pressure cuff, stethoscope and clock with a second hand, the whole process would be impossible.

With so many people having worked so hard to get to this stage, we had to get it right. Enter Dr Ahmed Seedat, medical doctor and troubleshooter with an impressive medical CV that also includes sourcing equipment, knowledge of plumbing, tiling, grouting and tireless negotiation. Ahmed soon helped smooth out those final few details just in time for Monday launch.

Setting up a triage takes time and contributions from many people, and I’m happy to say there was no reluctance from anyone to step up and help. With set up complete, now we just needed to start….