Effectiveness of a structured triage system in improving timeliness of emergency care in a resource-limited rural hospital in Uganda
Dublin Core
Title
Effectiveness of a structured triage system in improving timeliness of emergency care in a resource-limited rural hospital in Uganda
Subject
Triage, Emergency medical services, Rural hospitals, Developing countries, Resource-limited settings
Description
Abstract
Background Triage is essential for optimising resource allocation in emergency care, particularly in low- and middle-
income countries. Some triage tools, such as the Interagency Integrated Triage Tool (IITT), have been developed
specifically for resource-limited settings, but their implementation and evaluation remain challenging due to
shortages of staff, limited training opportunities, and infrastructure constraints. This study aimed to evaluate the
impact of implementing a structured triage system adapted from the IITT on the identification of urgent/emergency
cases and wait times compared with unstructured nursing assessment alone in a rural general hospital in Uganda.
Methods A prospective quality improvement study was conducted in the outpatient department (OPD) of Dr
Ambrosoli Memorial Hospital in Kalongo, Uganda. Data were collected on all patients attending the OPD for 7
consecutive days before and after IITT implementation. Outcomes included changes in emergency/urgent cases
identification, proportion of undertriage/overtriage using hospital admission as the gold standard for assessing triage
accuracy, OPD wait times and total OPD length of stay. Multivariable regression was used to adjust for confounders.
Results A total of 304 patients in the pre-implementation period and 246 patients in the post-implementation
period were included in the analysis. After implementation of the IITT, the proportion of emergency/urgent
cases increased from 16.4% to 22.8%, but there was no significant association between IITT implementation and
identification of emergency/urgent cases, overtriage and undertriage after adjustment for confounders. IITT
implementation was associated with a 23-minute reduction in time to provider (95% CI -35.49 to -12.03, p<0.001) and
a 35-minute reduction in total OPD length of stay (95% CI -57.41 to -12.76, p=0.002).
Conclusions A structured triage system adapted from the IITT showed similar proportions of overtriage and
undertriage compared with unstructured nursing assessment alone, but improved patient flow by significantly
reducing wait times and length of stay in the OPD of a resource-limited rural hospital in Uganda. These findings
suggest that structured triage can be feasibly implemented without additional resources in similar low-resource
hospitals; however, further studies are needed to fully assess the impact of IITT in this and similar settings.
Background Triage is essential for optimising resource allocation in emergency care, particularly in low- and middle-
income countries. Some triage tools, such as the Interagency Integrated Triage Tool (IITT), have been developed
specifically for resource-limited settings, but their implementation and evaluation remain challenging due to
shortages of staff, limited training opportunities, and infrastructure constraints. This study aimed to evaluate the
impact of implementing a structured triage system adapted from the IITT on the identification of urgent/emergency
cases and wait times compared with unstructured nursing assessment alone in a rural general hospital in Uganda.
Methods A prospective quality improvement study was conducted in the outpatient department (OPD) of Dr
Ambrosoli Memorial Hospital in Kalongo, Uganda. Data were collected on all patients attending the OPD for 7
consecutive days before and after IITT implementation. Outcomes included changes in emergency/urgent cases
identification, proportion of undertriage/overtriage using hospital admission as the gold standard for assessing triage
accuracy, OPD wait times and total OPD length of stay. Multivariable regression was used to adjust for confounders.
Results A total of 304 patients in the pre-implementation period and 246 patients in the post-implementation
period were included in the analysis. After implementation of the IITT, the proportion of emergency/urgent
cases increased from 16.4% to 22.8%, but there was no significant association between IITT implementation and
identification of emergency/urgent cases, overtriage and undertriage after adjustment for confounders. IITT
implementation was associated with a 23-minute reduction in time to provider (95% CI -35.49 to -12.03, p<0.001) and
a 35-minute reduction in total OPD length of stay (95% CI -57.41 to -12.76, p=0.002).
Conclusions A structured triage system adapted from the IITT showed similar proportions of overtriage and
undertriage compared with unstructured nursing assessment alone, but improved patient flow by significantly
reducing wait times and length of stay in the OPD of a resource-limited rural hospital in Uganda. These findings
suggest that structured triage can be feasibly implemented without additional resources in similar low-resource
hospitals; however, further studies are needed to fully assess the impact of IITT in this and similar settings.
Creator
Lucrezia Rovati1,2* , Samuel Otim3
, Sara Ottolenghi1,2, Maurice Okao3
, Fausto Fazzini2
, Alex Ojera3
,
Giovanni Carpani4
, Sandro Di Domenico2
, Laura Ferrari2
, Marco Bettina1,2, Daniele Privitera5
, Nicolò Capsoni1,2,
Godfrey Smart Okot3
, Carmen Orlotti3
and Michele Bombelli1,4
, Sara Ottolenghi1,2, Maurice Okao3
, Fausto Fazzini2
, Alex Ojera3
,
Giovanni Carpani4
, Sandro Di Domenico2
, Laura Ferrari2
, Marco Bettina1,2, Daniele Privitera5
, Nicolò Capsoni1,2,
Godfrey Smart Okot3
, Carmen Orlotti3
and Michele Bombelli1,4
Source
https://doi.org/10.1186/s12245-025-01005-z
Date
2025
Contributor
Peri Irawan
Format
pdf
Language
english
Type
text
Files
Collection
Citation
Lucrezia Rovati1,2* , Samuel Otim3
, Sara Ottolenghi1,2, Maurice Okao3
, Fausto Fazzini2
, Alex Ojera3
,
Giovanni Carpani4
, Sandro Di Domenico2
, Laura Ferrari2
, Marco Bettina1,2, Daniele Privitera5
, Nicolò Capsoni1,2,
Godfrey Smart Okot3
, Carmen Orlotti3
and Michele Bombelli1,4, “Effectiveness of a structured triage system in improving timeliness of emergency care in a resource-limited rural hospital in Uganda,” Repository Horizon University Indonesia, accessed April 11, 2026, https://repository.horizon.ac.id/items/show/12840.