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 (Print)
;
9(4): 172-176, 2019. ilus
Artigo
em Inglês
| AIM
| ID: biblio-1258709
ABSTRACT
Introduction The majority of emergency paediatric death in African countries occur within the first 24â¯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. 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 15â¯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; MRRâ¯=â¯0.55; 0.38, 0.81; pâ¯=â¯0.002), compared to before. To estimate the agreement between non-clinical and clinical staff, 548 (of the 671) patient files were included. The agreement was estimated at 88.7% (Kappaâ¯=â¯0.644; pâ¯<â¯0.001). The median waiting time decreased with urgency of the triage 2â¯h33 for 'green'/least serious (IQR 1â¯h58-3â¯h30), 21â¯min for yellow/serious (IQR 0â¯h10-0â¯h58) and nine minutes for 'red'/urgent (IQR 240â¯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 supports scaling this intervention in similar settings
Texto completo:
DisponíveL
Índice:
AIM (África)
Assunto principal:
Organização Mundial da Saúde
/
Hospitais Rurais
/
Triagem
/
Medicina de Emergência Pediátrica
/
Hospitais de Distrito
/
Moçambique
Tipo de estudo:
Estudo prognóstico
País/Região como assunto:
África
Idioma:
Inglês
Revista:
African journal of emergency medicine (Print)
Ano de publicação:
2019
Tipo de documento:
Artigo
Similares
MEDLINE
...
LILACS
LIS