Jurnal Internasional Afrika vol.9 issue.4 2019
African Journal of Emergency Medicine
Triage conducted by lay-staff and emergency training reduces paediatric mortality in the emergency department of a rural hospital in Northern Mozambique
Dublin Core
Title
Jurnal Internasional Afrika vol.9 issue.4 2019
African Journal of Emergency Medicine
Triage conducted by lay-staff and emergency training reduces paediatric mortality in the emergency department of a rural hospital in Northern Mozambique
African Journal of Emergency Medicine
Triage conducted by lay-staff and emergency training reduces paediatric mortality in the emergency department of a rural hospital in Northern Mozambique
Subject
Emergency care
Triage
Critical ill children
Africa
ETAT
Task-shifting
Triage
Critical ill children
Africa
ETAT
Task-shifting
Description
Introduction: The majority of emergency paediatric death in African countries occur within the first 24 h of
admission. A coloured triage system is widely implemented in high-income countries and the emergency triage
and assessment treatment (ETAT) is recommended by the World Health Organization, but not put into practice
in Mozambique. We implemented a three-colour triage system in a rural district hospital with lay-staff workers
conducting the first triage.
Methods: A retrospective, before and after, mortality analysis was performed using routine patient files from the
district hospital between 2014 and 2017. The triage system was implemented in August 2016. Inclusion criteria
were children under 15 years of age that entered the emergency centre. Primary outcome was child mortality
rate. Secondary outcomes included the percentage agreement between the clinical and non-clinical staff and the
duration from triage to first treatment. We used a negative binomial model in STATA 15 to compare mortality
rates, and Kappa statistics to estimate the agreement between clinical and non-clinical staff.
Results: 4176 admissions were included. The mortality rate ratio (MMR) was 45% lower after the start of the
intervention (2016; MRR = 0.55; 0.38, 0.81; p = 0.002), compared to before. To estimate the agreement be-
tween non-clinical and clinical staff, 548 (of the 671) patient files were included. The agreement was estimated
at 88.7% (Kappa = 0.644; p < 0.001). The median waiting time decreased with urgency of the triage: 2 h33 for
‘green’/least serious (IQR 1 h58-3 h30), 21 min for yellow/serious (IQR 0 h10-0 h58) and nine minutes for ‘red’/
urgent (IQR 2–40 min).
Conclusion: In a rural setting with nurse-led clinical care and non-clinician staff working at the triage reception,
implementation of a three-coloured triage system was feasible. Triage and ETAT training was associated with a
decrease of 45% of paediatric deaths. The impact on mortality, low cost, and ease of the implementation sup-
ports scaling this intervention in similar settings.
admission. A coloured triage system is widely implemented in high-income countries and the emergency triage
and assessment treatment (ETAT) is recommended by the World Health Organization, but not put into practice
in Mozambique. We implemented a three-colour triage system in a rural district hospital with lay-staff workers
conducting the first triage.
Methods: A retrospective, before and after, mortality analysis was performed using routine patient files from the
district hospital between 2014 and 2017. The triage system was implemented in August 2016. Inclusion criteria
were children under 15 years of age that entered the emergency centre. Primary outcome was child mortality
rate. Secondary outcomes included the percentage agreement between the clinical and non-clinical staff and the
duration from triage to first treatment. We used a negative binomial model in STATA 15 to compare mortality
rates, and Kappa statistics to estimate the agreement between clinical and non-clinical staff.
Results: 4176 admissions were included. The mortality rate ratio (MMR) was 45% lower after the start of the
intervention (2016; MRR = 0.55; 0.38, 0.81; p = 0.002), compared to before. To estimate the agreement be-
tween non-clinical and clinical staff, 548 (of the 671) patient files were included. The agreement was estimated
at 88.7% (Kappa = 0.644; p < 0.001). The median waiting time decreased with urgency of the triage: 2 h33 for
‘green’/least serious (IQR 1 h58-3 h30), 21 min for yellow/serious (IQR 0 h10-0 h58) and nine minutes for ‘red’/
urgent (IQR 2–40 min).
Conclusion: In a rural setting with nurse-led clinical care and non-clinician staff working at the triage reception,
implementation of a three-coloured triage system was feasible. Triage and ETAT training was associated with a
decrease of 45% of paediatric deaths. The impact on mortality, low cost, and ease of the implementation sup-
ports scaling this intervention in similar settings.
Creator
Johanna Dekker-Boersema, Jonas Hector, Laura Frances Jefferys, Clemência Binamo,Deavis Camilo, Gerard Muganga, Mussa Manuel Aly, Ernesto Belario Rafael Langa, Penelope Vounatsou, Michael André Hobbins
Source
https://doi.org/10.1016/j.afjem.2019.05.005
Date
20 May 2019
Contributor
PERI IRAWAN
Format
PDF
Language
ENGLISH
Type
TEXT
Files
Citation
Johanna Dekker-Boersema, Jonas Hector, Laura Frances Jefferys, Clemência Binamo,Deavis Camilo, Gerard Muganga, Mussa Manuel Aly, Ernesto Belario Rafael Langa, Penelope Vounatsou, Michael André Hobbins, “Jurnal Internasional Afrika vol.9 issue.4 2019
African Journal of Emergency Medicine
Triage conducted by lay-staff and emergency training reduces paediatric mortality in the emergency department of a rural hospital in Northern Mozambique,” Repository Horizon University Indonesia, accessed February 5, 2025, https://repository.horizon.ac.id/items/show/1783.
African Journal of Emergency Medicine
Triage conducted by lay-staff and emergency training reduces paediatric mortality in the emergency department of a rural hospital in Northern Mozambique,” Repository Horizon University Indonesia, accessed February 5, 2025, https://repository.horizon.ac.id/items/show/1783.