Emergency Department Triage in a Resource Constrained Setting: Application of the World Health Organization Triage Scale in Regional Papua New Guinea
试验速览
- 阶段
- 不适用
- 状态
- 撤回
- 入组人数
- 16,800
- 试验地点
- 1
- 主要终点
- Time-to-assessment (TTA) by an ED clinician for ten time-critical conditions
研究概览
简要总结
Triage is an important component of emergency care (EC). It aims to sort patients based on the urgency of their condition such that the highest acuity patients are prioritised for assessment and treatment. Grounded in the ethical principles of equity and justice, triage is necessary whenever there is a mismatch between demand for EC and the availability of resources.
Globally, a large number of triage scales are in use. These differ in the data required to categorise patients as well as the number of tiers. Developed settings tend to utilise five-tier systems.
Little is known about the prevalence of triage in low- and middle-income countries (LMICs), including in the Pacific region. There is also limited evidence about the utility, validity and reliability of triage scales in these contexts. While a landmark study in a paediatric Emergency Department (ED) in Malawi demonstrated that training staff in emergency skills, introducing triage and improving flow substantially reduced case fatality rates, the mortality reduction attributable to triage is unknown.
A small number of triage scales have been developed for resource-limited (RL) environments. The most widely studied is the four-tier South African Triage Scale (SATS), which has demonstrated reasonable reliability and validity. In the Pacific region, SATS has provided a foundation for the three-tier Solomon Islands Triage Scale (SITS), which has recently been piloted in Honiara. The World Health Organization (WHO) has also recently released a three-tier triage scale. Neither of these instruments has been validated.
Although the potential value of triage systems in resource-limited EDs is increasingly recognised, the current evidence base is limited. The impact on process indicators (eg, time to assessment) and clinical outcomes (eg, mortality) for time-critical conditions is largely unknown. This study aims to address this knowledge gap.
详细描述
BACKGROUND
Triage is an important component of emergency care (EC). It aims to sort patients based on the urgency of their condition such that the highest acuity patients are prioritised for assessment and treatment. Grounded in the ethical principles of equity and justice, triage is necessary whenever there is a mismatch between demand for EC and the availability of resources.
Globally, a large number of triage scales are in use. These differ in the data required to categorise patients as well as the number of tiers. Developed settings tend to utilise five-tier systems, principally based on validation studies performed in Australia in the 1990s. The triage process is less efficient in these models, because triage nurses (who typically perform emergency department triage) take longer to assess and differentiate category three and four patients.
There have been few attempts to compare the performance of triage scales. A 2011 systematic review concluded that current scales were supported by limited or insufficient evidence, and suggested that "head-to-head comparisons are required to determine whether any of the scales have advantages over the others".
Triage in developing emergency care systems
研究设计
- 研究类型
- Interventional
- 分配方式
- Non Randomized
- 干预模型
- Sequential
- 主要目的
- Health Services Research
- 盲法
- None
入排标准
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- 未提供
排除标准
- 未提供
研究组 & 干预措施
Pre-intervention
Pre-intervention period
Post-intervention
Post-intervention period
干预措施: Introduction of the World Health Organization Triage Scale (Other)
结局指标
主要结局
Time-to-assessment (TTA) by an ED clinician for ten time-critical conditions
时间窗: Time interval between the patient's arrival in ED and assessment by a treating clinician, assessed up to 24 hours following arrival
The primary outcome will be time-to-assessment (TTA) by an ED clinician for ten time-critical conditions: severe trauma, major burns, severe head injury, ruptured ectopic pregnancy, septic shock, myocardial infarction, severe asthma/COPD, severe pneumonia, meningitis and appendicitis.
The proportion of patients selected clinical syndromes that are seen within a clinically appropriate timeframe
时间窗: Within 15 minutes of arrival
The primary outcome will also be analysed by the proportion of patients with these clinical syndromes that are seen within a clinically appropriate timeframe (defined as 15 minutes)
次要结局
- Length of hospital stay(The duration of the hospital stay at the point of hospital discharge, assessed up to 1 month following admission)
- ED mortality(Within the ED encounter, assessed up to approximately 7 days)
- Inpatient mortality(Prior to discharge from the hospital, assessed up to 1 month post-admission)