Adapting a novel emergency triage tool to a resource-limited hospital in Nepal
Dublin Core
Title
Adapting a novel emergency triage tool to a resource-limited hospital in Nepal
Subject
Triage, Emergency department, Quality improvement, Nepal, Global health
Description
Abstract
Background Effective triage is critical for prioritizing emergency care. However, many low- and middle-income
countries lack standardized triage systems. Nepal has been working to introduce the WHO’s Interagency Integrated
Triage Tool (IITT) into emergency departments nationwide. Still, successful implementation requires context-specific
adaptations to address operational realities and resource constraints.
Objective This study aimed to collaboratively adapt the IITT for use in the Dhulikhel Hospital Emergency Department
by incorporating frontline staff insights to develop a feasible, sustainable triage workflow.
Methods Five focus groups composed of doctors, nurses, and paramedics were conducted. Through semi-structured
discussions, we explored staff perceptions of areas for improvement in the existing triage processes. Participants then
generated site-specific workflow models through iterative brainstorming sessions, progressively refining the design
into a final consensus-based model.
Results Participants, representing over 80% of clinical staff, identified key barriers to effective triage, including
inconsistent communication, unclear handoff responsibilities, and insufficient training. The final triage workflow
addressed many critical challenges raised in discussion sessions, provided a standardized and customized triage
process, and resulted in high reported confidence in its utility.
Conclusion This study demonstrates the value of a bottom-up, staff-centered approach to triage system
development and implementation. Our focus group design offers a practical, replicable framework for low-resource
emergency departments seeking to implement the IITT or similar protocols into their ED operations. Future efforts
should focus on validating the workflow’s impact on patient outcomes and triage efficiency and investing in
thorough and longitudinal training to support sustained adoption.
Keywords Triage, Emergency department, Quality improvement, Nepal, Global health
Background Effective triage is critical for prioritizing emergency care. However, many low- and middle-income
countries lack standardized triage systems. Nepal has been working to introduce the WHO’s Interagency Integrated
Triage Tool (IITT) into emergency departments nationwide. Still, successful implementation requires context-specific
adaptations to address operational realities and resource constraints.
Objective This study aimed to collaboratively adapt the IITT for use in the Dhulikhel Hospital Emergency Department
by incorporating frontline staff insights to develop a feasible, sustainable triage workflow.
Methods Five focus groups composed of doctors, nurses, and paramedics were conducted. Through semi-structured
discussions, we explored staff perceptions of areas for improvement in the existing triage processes. Participants then
generated site-specific workflow models through iterative brainstorming sessions, progressively refining the design
into a final consensus-based model.
Results Participants, representing over 80% of clinical staff, identified key barriers to effective triage, including
inconsistent communication, unclear handoff responsibilities, and insufficient training. The final triage workflow
addressed many critical challenges raised in discussion sessions, provided a standardized and customized triage
process, and resulted in high reported confidence in its utility.
Conclusion This study demonstrates the value of a bottom-up, staff-centered approach to triage system
development and implementation. Our focus group design offers a practical, replicable framework for low-resource
emergency departments seeking to implement the IITT or similar protocols into their ED operations. Future efforts
should focus on validating the workflow’s impact on patient outcomes and triage efficiency and investing in
thorough and longitudinal training to support sustained adoption.
Keywords Triage, Emergency department, Quality improvement, Nepal, Global health
Creator
Yael Weiner1*, Claire Therriault1*, Tina Duwal2
, Samjhana Basnet2
, Roshana Shrestha2
and Sanu Krishna Shrestha2*
, Samjhana Basnet2
, Roshana Shrestha2
and Sanu Krishna Shrestha2*
Date
2025
Contributor
Peri Irawan
Format
pdf
Language
english
Type
text
Files
Collection
Citation
Yael Weiner1*, Claire Therriault1*, Tina Duwal2
, Samjhana Basnet2
, Roshana Shrestha2
and Sanu Krishna Shrestha2*, “Adapting a novel emergency triage tool to a resource-limited hospital in Nepal,” Repository Horizon University Indonesia, accessed April 18, 2026, https://repository.horizon.ac.id/items/show/13257.