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Surgical-triage System
| Colour / Priority | Groote Schuur Emergency Surgery Triage (GSEST 2023) Target to OT |
South African Triage Scale–SATS (ED usable) Target clinician review |
NCEPOD (UK 2004) | NSW Acute Surgery Priority (AUS 2015) |
|---|---|---|---|---|
| Red–Immediate | Immediate Life-saving surgery with concurrent resuscitation (e.g. ruptured AAA, resuscitative laparotomy, threatened airway) |
Resus room now | Immediate | < 15 min |
| Orange–Expedited / Very-urgent | 1–2 h Surgery ASAP once haemodynamics stabilised (e.g. ruptured ectopic, leaking AAA) |
Clinician < 10 min | – | < 1 h |
| Yellow–Urgent | ≤ 6 h Time-sensitive but not exsanguinating (e.g. appendicitis, incarcerated hernia) |
Clinician < 60 min | Urgent (within hours) | < 4 h (organ/limb threat) |
| Green–Emergent / Non-urgent | ≤ 24 h Definitive care before next day (e.g. ORIF simple fracture) |
Clinician < 4 h | Expedited (within days) | < 24 h |
| Blue–Scheduled / Semi-urgent | ≤ 72 h Stable, suitable for in-hours list |
“Blue” SATS = certification / death admin | Elective | < 72 h (semi-urgent) |
- Key points
- GSEST aligns colour palette with SATS to reduce cognitive load across ED→ theatre pathway.
- “Blue–Expectant” in disaster triage (= palliative) excluded from routine theatre list management.
- Target times start at booking; monitor compliance on live dashboard.
Practical Triage Workflow (GSH model)
- Anaesthetic Triage Registrar (ATR) reviews case, assigns colour, documents optimisation tasks.
- Real-time booking into electronic board visible to OT charge nurse and night coordinator.
- Escalation triggers–if Red not in theatre within 15 min or Orange not within 90 min, consultant call-back is automatic.
- Quarterly audit: colour allocated vs actual knife-to-skin time; feed into risk register.
Decision Aids for Colour Allocation
| Red if any present | Orange if any present | Yellow if both present |
|---|---|---|
| Active exsanguination; GCS < 8 airway risk; Foetal heart < 80 bpm | Haemodynamic instability responding to fluids/pressors; CT evidence of impending herniation; threatened limb ischaemia | Rising lactate but stable BP; closed-loop bowel obstruction without peritonitis; open fracture without compromised limb perfusion |
- (Adapted from RCoA 2024 guidelines & GSH policy v3.2.)
Core Concepts to Remember
- Triage ≠ once-off: reassess at hand-over, post-CT, and after optimisation.
- Prioritisation is based on surgical acuity, not surgeon availability–protected emergency list time reduces cancellations.
- Align anaesthetic risk optimisation (e.g. FBC, G&S, POCUS fluid status) with colour category to avoid unsafe delays.
Links
References:
- Part II Anaesthesia Refresher Course–2016 University of Cape Town Triaging of Emergency Surgical Cases Dr Felipé Montoya-Pelaez
- Western Cape DoH & Groote Schuur Hospital. GSEST Policy v3.2–Emergency Theatre Prioritisation. 2023.
- South African Triage Group. SATS Adult & Paediatric Charts v5.1. 2022.
- National Confidential Enquiry into Patient Outcome and Death. Classification of Intervention Urgency. 2004.
- NSW Health Surgical Services Taskforce. Acute Surgery Model of Care. 2015.
- Royal College of Anaesthetists. Guidelines for the Provision of Emergency Anaesthesia Services (GPAS 2024).
Summaries:
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© 2025 Francois Uys. All Rights Reserved.
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