Impact of an Emergency Triage Assessment and Treatment (ETAT)-based triage process in the paediatric emergency department of a Guatemalan public hospital. (2nd July 2016)

• Record Type: Journal Article
• Authors: Crouse, Heather L.; Torres, Francisco; Vaides, Henry; Walsh, Michael T.; Ishigami, Elise M.; Cruz, Andrea T.; Torrey, Susan B.; Soto, Miguel A.
• Is Part Of: Paediatrics and international child health. Volume 36:Number 3(2016:Aug.)
• Page Start: 219
• Page End: 224
• Publication Date: 2016-07-02
• Subjects: Paediatric emergency medicine -- Paediatric triage -- International emergency medicine -- Emergency Triage Assessment and Treatment (ETAT) -- Clasificación -- Evaluación y Tratamiento de Emergencias Pediátricas (CETEP); ETAT -- Emergency Triage Assessment and Treatment -- HCW, shealthcare workers -- HNPB, Hospital Nacional Pedro Bethancourt -- BCM/TCH, Baylor College of Medicine/Texas Children's Hospital -- MoH, Guatemalan Ministry of Health -- PAHO, Pan-American Health Organization -- CETEP, Clasificación Evaluación y Tratamiento de Emergencias Pediátricas -- PED, paediatric emergency department -- PICU, paediatric intensive care unit -- QI, quality improvement -- LOS, inpatient length of stay -- RS, random sample -- CI, critically ill sample; Pediatrics -- Developing countries -- Periodicals; Children -- Health and hygiene -- Developing countries -- Periodicals; Children -- Diseases -- Developing countries -- Periodicals; 618.920009172405
• DOI: 10.1179/2046905515Y.0000000026
• Languages: English
• ISSNs: 2046-9047

Abstract

Abstract : Background: Triage process implementation has been shown to be effective at improving patient outcomes. This study sought to develop, implement and assess the impact of an Emergency Triage Assessment and Treatment (ETAT)-based emergency triage process in the paediatric emergency department (PED) of a public hospital in Guatemala. Methods: The study was a quality improvement comparison with a before/after design. Uptake was measured by percentage of patients with an assigned triage category. Outcomes were hospital admission rate, inpatient length of stay (LOS), and mortality as determined by two distinct medical record reviews for 1 year pre- and post-intervention: a random sample (RS) of all PED patients and records for all critically-ill (CI) children [serious diagnoses or admission to the paediatric intensive care unit (PICU)]. Demographics, diagnoses and disposition were recorded. Results: The RS totalled 1027 (51.4% male); median ages pre- and post-intervention were 2.0 and 2.4 years, respectively. There were 196 patients in the CI sample, of whom 56.6% were male and one-third were neonates; median ages of the CI group pre- and post-intervention were 3.1 and 5.6 months, respectively. One year after implementation, 97.5% of medical records had been assigned triage categories. Triage categories (RS/CI) were: emergency (2.9%/54.6%), priority (47.6%/44.4%) and non-urgent (49.4%/1.0%). The CI group was more frequently diagnosed with shock (25%/1%), seizures (9%/0.5%) and malnutrition (6%/0.5%). Admission rates for the RS (8% vs 4%, P= 0.01) declined after implementation. For the CI sample, admission rate to the PICU (47% vs 24%, P= 0.002) decreased and LOS (7.3 vs 5.7 days, P= 0.09) and mortality rates (12% vs 6%, P= 0.15) showed trends toward decreasing post-implementation. Conclusions: Paediatric-specific triage algorithms can be implemented and sustained in resource-limited settings. Significant decreases in admission rates (both overall and for the PICU) and trends towards decreased LOS and mortality rates of critically ill children suggest that ETAT-based triage systems have the potential to greatly improve patient care in Latin America.