Background: Triage training and implementation in resource-limited settings (RLS) improves outcomes for acutely ill children. Emergency Triage Assessment and Treatment (ETAT) is a simple 3-category triage algorithm and training program developed by the WHO to improve assessment and initial management of children in RLS. In Belize (Central America) pediatric triage practice varies with setting. The government referral hospital (GRH) uses a complex 5-category Emergency Severity Index (ESI) while the government health centers (GHC) have no formal triage process. Studies of ETAT implementation have been performed in RLS where no prior triage system exists; however, data in RLS with existing triage systems are lacking. Purpose: To explore healthcare providers’ (HCP) attitudes toward the current triage system prior to national pediatric triage implementation. Methods: A qualitative study was performed via purposive sampling of HCPs that participated in an ETAT training course using focus groups and semi-structured interviews at two time points: immediately after an initial ETAT training and 1 year after as the country prepared for a phased national ETAT training rollout. The focus groups were digitally recorded and transcribed. Two coders analyzed all transcripts to identify emerging themes. Constant comparison analysis was performed until achieving thematic saturation. Results: 16 HCPs (7 physicians and 9 nurses) participated after ETAT training and 24 HCPs (15 physicians and 9 nurses; 11 [68%] from first focus groups) participated one year later. The following principal themes emerged regarding current triage systems: The initial groups stressed (1) the importance of triage education and implementation to standardize and improve communication by using a unified language between HCPs (2) desire to implement a simple, low-resource pediatric-specific triage system and (3) major limitations of ESI included the difficulties of assessing pediatric patients due to its complexity and lack of pediatric specific criteria as well as dependence on equipment that is not consistently available. GHCs expressed interest in developing a triage system based on ETAT. One year following ETAT training, some GHCs are implementing ETAT-based triage systems independently with qualitative success stories and want to continue trainings and formalize ETAT-based triage implementation. The GRH reports that ETAT allows them to triage children more effectively than ESI given the simple algorithm and pediatric focus. Participants believe it improves communication between HCPs. Conclusions: Participants feel that triage education and implementation is essential to improve communication and pediatric emergency care and agree that a national pediatric triage system would be beneficial. Prior to triage implementation all staff should be educated in the new process. When choosing which system to use a simple, low-resource pediatric-specific system, like ETAT, may improve utilization by staff providing faster recognition of and improved care for acutely ill children. These beliefs should be considered when addressing triage implementation in RLS.
Healthcare Provider Attitudes Toward the Emergency Triage System in Belize
- Views Icon Views
- Share Icon Share
- Search Site
Alicia E. Genisca, Esther Sampayo, Joy M. Mackey, Lisa J. Johnson, Heather L. Crouse; Healthcare Provider Attitudes Toward the Emergency Triage System in Belize. Pediatrics May 2018; 142 (1_MeetingAbstract): 519. 10.1542/peds.142.1MA6.519
Download citation file: