The Solomon Islands Triage Scale (SITS)
By Lynne Wanefalea
Hi! My name is Lynne Wanefalea and I’m a clinical nurse specialist in emergency nursing with a Masters in Intensive care. I also teach at Monash University as an educator in clinical skills and simulation. I recently spent 12 months in the Solomon Islands as part of a program to assist the transition for medical students returning to Honiara from Cuba to consolidate their learning and spent my time within the emergency department at the National Referral Hospital in Honiara doing lots of education with both the doctors and nurses. While I was there it was clear that an important priority was to review and develop the triage process. This is the story of our long road to a new triage system, which is called SITS (Solomon Island Triage Scale) A link the version for adults and the version for children can be found under the ‘Resources’ tab)
The original triage system in the Solomons was loosely based on the Australasian Triage Scale (also under the ‘Resources’ tab), but it wasn’t suited to the local setting, and this made it difficult for staff to use it or understand it.
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Starting a new system in any setting is difficult and there is MUCH groundwork to be done first. It is very important to decide who the key stakeholders in your setting and involve them from the beginning. These people will keep the process going through the tough times if they can understand what the end result will be and the benefit for the workplace, patients and staff.
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Understanding how the flow of patients through the department works from a triage perspective is also very important. Looking at exactly WHERE patients can be assessed and WHO will be assessing them and treating them is vital. How will the system flow? Do you have the assessment equipment needed to do this and a private and safe space to carry it out? Where do patients go after assessment? In our case we cleaned out a room that was being used to store medical records and made an extra assessment and treatment room, then hung a curtain in another under-used space to allow proper assessments to be carried out. Security was employed to try and stop too many extra people filling up the department (eg: large numbers of worried relatives, people coming in without being triaged, etc).
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A new building for triaging patients in a safe and more private setting was built on the front verandah. Fundraising was done to provide equipment packs for each staff member so they could look after their own equipment and always have what they needed available to assess patients.
Training the staff in understanding and using the guidelines for triage was also an important step.
How do you know when someone is critically unwell?
What parameters are we checking this against?
Several simple flowcharts and diagrams were developed, and much training carried out for both nurses and doctors, including the importance of documentation.
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The Solomon Islands Triage Scale (SITS) is based on a combination of the South African Triage Scale and the World Health Organisation paediatric model. It is a simplified 3-tier model that seems to be working effectively in it’s setting. The challenge of staff, space and resources remains. It is very exciting to see the system being used. Remember a whole of hospital approach needs to be adopted. Once the patient is triaged and treated, where do they go from there? The speciality units need to be informed of changes also in order to provide the best patient journey possible and to keep the patient stay in ED as short as possible while still providing good care.
If you are considering such a change in your local setting that is fantastic! Please remember however there are MANY challenges around introducing such a major change into practice. It took twelve months to research, design and implement this system in the Solomon Islands and it included the help and support of many people along the way and a huge amount of time and resources. Understanding this and being prepared for it will go a long way in ensuring ongoing success.
Additional Resources
The Australasian Triage Score (ATS)
