Replication Study: Evaluating the Impact of the South African Triage Scale on Emergency Department Mortality in a Mozambican Regional Hospital, 2009

The South African Triage Scale (SATS) is a tool for prioritising care in resource-limited emergency departments. While its implementation has been linked to reduced mortality in some African settings, evidence from Mozambique is scarce. A prior study in South Africa showed benefit, prompting this replication to assess transferability. This replication study evaluated the impact of SATS in a distinct Mozambican context. The primary objective was to determine its effect on all-cause emergency department mortality. Secondary objectives were to assess compliance with the scale and to identify operational barriers. A quasi-experimental, before-and-after study was conducted. The pre-implementation phase involved a retrospective analysis of routine emergency department data. The post-implementation phase prospectively collected data after a formal SATS training programme for nursing staff. All consecutive patients presenting during the study periods were included. The primary outcome was crude emergency department mortality. SATS implementation was associated with a reduction in crude emergency department mortality. Mortality decreased from 4.8% pre-implementation to 3.1% post-implementation. Initial nursing compliance with triage documentation was high but declined over time. Key operational challenges included high patient volumes and frequent staff rotation. The study confirms that introducing SATS in a Mozambican regional hospital was associated with reduced emergency department mortality. This supports the role of standardised triage in improving outcomes in comparable resource-constrained environments. Sustaining benefits requires ongoing training and mentorship to counter declining compliance and staff turnover. Future work should integrate triage with quality improvement cycles and examine impacts on specific high-risk patient groups. Hospital management should address identified operational constraints. Triage; Emergency Service, Hospital; Mortality; Mozambique; South African Triage Scale; Implementation Science. This replication study provides contextual evidence for the SATS in a Mozambican public hospital, informing emergency care policy and practice in similar health systems.