Emergency Department Triage in a Resource Constrained Setting: Application of the World Health Organization Triage Scale in Regional Papua New Guinea

NCT04098705 | Withdrawn

• 1 other identifier: 19106
• Study Type: interventional
• Target: N/A
• Locations: 1 country
• Sites: 1

Brief Summary

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.

Conditions

Emergencies

Outcome Measures

Primary Outcomes (2)

• Time-to-assessment (TTA) by an ED clinician for ten time-critical conditions

  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.

  Time interval between the patient's arrival in ED and assessment by a treating clinician, assessed up to 24 hours following arrival

• The proportion of patients selected clinical syndromes that are seen within a clinically appropriate timeframe

  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)

  Within 15 minutes of arrival

Secondary Outcomes (3)

• 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

Other Outcomes (5)

• Validity - predictive ability for disposition

  The patient's ED encounter, assessed up to approximately 7 days following arrival in the ED

• Validity - predictive ability for death

  The patient's ED encounter, assessed up to approximately 7 days following arrival in the ED

• Under- and over-triage rates

  The patient's ED encounter, assessed up to approximately 7 days following arrival in the ED

Study Arms (2)

Pre-intervention

NO INTERVENTION

Pre-intervention period

Post-intervention

EXPERIMENTAL

Post-intervention period

Other: Introduction of the World Health Organization Triage Scale

Interventions

Introduction of the World Health Organization Triage Scale OTHER

The intervention will comprise implementation of a new triage and patient flow system facilitated through staff training and clinical redesign. The three-tier World Health Organization Triage Scale (WHOTS) will be used as the triage instrument. This tool, developed collaboratively by the WHO, International Committee of the Red Cross (ICRC) and Médecins Sans Frontières (MSF), incorporates features of the South African Triage Scale but has been modified for application in a wide variety of RL settings. WHOTS documents are provided in the research protocol.

Post-intervention

Eligibility Criteria

• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)

You may qualify if:

• All patients presenting to Mount Hagen Provincial Hospital during the study period.

You may not qualify if:

• None.

Sponsors & Collaborators

• Monash University: lead
• Western Highlands Provincial Health Authority: collaborator
• Queensland Health: collaborator
• The Alfred: collaborator

Study Sites (1)

Mount Hagen Provincial Hospital

Mount Hagen, Western Highlands Province, Papua New Guinea

Location

MeSH Terms

Conditions

Emergencies

Condition Hierarchy (Ancestors)

Disease Attributes; Pathologic Processes; Pathological Conditions, Signs and Symptoms

Study Officials

• Peter Cameron, FACEM

  Monash University

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NON RANDOMIZED
• Masking: NONE
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: SEQUENTIAL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Model Details: Pre-post intervention methodology will be used

Study Record Dates

• First Submitted: September 9, 2019
• First Posted: September 23, 2019
• Study Start: August 30, 2019
• Primary Completion: December 30, 2019
• Study Completion: February 29, 2020
• Last Updated: December 4, 2024

Record last verified: 2024-11

Locations

PA (1)