What HIFA2015 members say
Meeting information needs for effective triage
Please find below extracts from messages sent on the HIFA2015 and CHILD2015 email forums. There have been 14 messages on the subject to date, from 10 contributors in Burkina Faso, Kenya (2), Malawi, Switzerland, Tanzania (2), and UK (2). All messages to date have focused on triage in children, and especially on Emergency Triage Assessment and Treatment (ETAT).
1. Understanding information needs
1.1 Information needs reported by healthcare providers
Nil to date.
1.2 Information needs inferred through observation of practice
“”The importance of triage was driven home by the observation that many children who come to health centres literally die while waiting in the queue to be seen by the health worker – because there is often no system in place to help recognise those who need to be seen urgently.”
Neil Pakenham-Walsh and Steve Allen, UK (reporting on a presentation on experience in Malawi, by Anna Gregory, Leeds, UK, at the ICHG winter meeting, November 2006)
1.3 Information needs inferred through assessment of knowledge
Nil to date.
2. Undertaking and publishing research on triage
3. Synthesizing knowledge
“Any intervention to reduce the mortality must target the emergency triage assessment and treatment plus the initial admission care (ETAT+). To help improve hospital management of the major causes of inpatient childhood mortality we developed simple clinical practice guidelines (CPGs) for use in Kenya, a low-income setting. These guidelines were adapted from existing WHO materials by participatory process. To facilitate dissemination and implementation of the guidelines we developed a 5.5 days training programme… Our experience suggests that with sustained effort it is possible to develop locally owned, appropriate clinical practice guidelines for emergency and initial hospital care for seriously ill children with involvement of pertinent stake holders throughout. To ensure sustainability of such innovation it is fundamental to incorporate the training in the pre-service training and the medical teaching institutions…”
Grace Irimu, Kenya, March 2009
4. Making knowledge available
“You may wish to consult the following WHO publication:
‘Emergency Triage Assessment and Treatment (ETAT) course. Manual for Participants and Facilitator’s Guide’
Maryvonne Grisetti, Switzerland, February 2008
5. Applying knowledge
“We have lots of experience of organizing ETAT at district level. We have done it as weekend courses, or as modules, as triage for everyone (ie gate keeper, porter, cleaner receptionist included) and then treatment for the clinical team. Our registrars have each adopted a district hospital and teach emergency Care and audit and review progress (vital for success I think) and each district hospital has an ETAT coordinator.”
Elizabeth Molyneux, Malawi, October 2006
Moulage
“It would be very useful to hear if anyone has experience of how to do moulage training effectively in poorer countries – where the models used in richer countries are not available. The ‘kit’ would have to be basic – so that the participants could also deliver the training themselves after the course. For example, to teach the initial assessment skills in ETAT (Emergency Triage Assessment and Treatment; a component of the WHO IMCI guidlines), how do you simulate a sick child in a classroom setting (obstructed breathing, signs of shock, etc.).”
Stephen Allen, UK, March 2009
“When I was setting up our assessment unit in Muheza we ran role play exercises as part of the education in emergency management. I had written out several ‘scenarios’, we didn’t have a dummy but just stood around the bed with a nurse and a clinical officer. We had ‘convulsing child’, ‘comatose child’ etc and ran through them… one of the most rewarding aspects of my time here has been watching that team of nurses and clinical officers learn how to manage paediatric emergencies with a simple ABC approach. So dummies are not really neccessary.”
Behzad Nadjm, Tanzania, March 2009
6. Measuring impact
“I think ETAT is well suited to a first line hospital with minimal support services and no spare staff. It is well established in our hospital in Malawi and has helped reduce the inpatient mortality by 50%.”
Elizabeth Molyneux, Malawi, October 2006
“The ETAT+ workshop approach was effective in terms of building the knowledge of health workers, but was expensive and time-consuming.”
Neil Pakenham-Walsh and Steve Allen, UK (reporting on a presentation on experience in Malawi by Anna Gregory, Leeds, UK, at the ICHG winter meeting, November 2006)
Contributors
Stephen Allen is a co-moderator and adviser for the CHILD2015 email discussion group. He is a Reader in Paediatrics and Honorary Consultant Paediatrician at the School of Medicine, Swansea University, UK. He is the Overseas Director for Africa for the David Baum International Foundation, and a committee member of the International Child Health Group, in association with the Royal College of Paediatrics and Child Health, UK. He has 4 years experience in Papua New Guinea and 6 years with the Medical Research Council, The Gambia, involved in training, research and clinical paediatrics. He has developed eLearning in international health in partnership with colleagues at the University College Hospital, Ibadan, Nigeria .
Maurice Fritzsche is a Swiss pediatrician working in a District Hospital/Research Centre in Nouna, Burkina Faso (Centre de Recherche en Santé de Nouna). The centre is currently organizing an ETAT
(emergency triage assessment and treatment) course.
Roly Gosling is working on the IPTi study (Intermittent Preventive Treatment of malaria in infants), Tanga, Tanzania
Maryvonne Grisetti works at the World Health Organization headquarters, Geneva. She is currently in charge of free dissemination of WHO priced publications worldwide but especially aimed at developing countries.
Grace W Irimu is a pediatrician and a lecturer in the Department of Paediatrics and Child Health, University of Nairobi, Kenya. She is involved in developing and disseminating ‘Guidelines for emergency care and the admission care of a seriously ill child’ for use in low income countries a task which has been undertaken by KEMRI Wellcome Trust, Nairobi and Ministry of Health Kenya. She has been a key person in introduction if Emergency Triage Assessment & Treatment plus Admission Care (ETAT+) as discipline taught to undergraduate and postgraduate students in the University of Nairobi, Kenya as well as the University teaching hospital.
Elizabeth Molyneux is Professor and Head of Paediatrics Department at the College of Medicine, Blantyre, Malawi. She has almost 30 years experience of practising medicine in the developing world. Her interests are wide but she is especially interested in quality improvement in child care at all levels, particularly within the hospital systems. Other interests include emergency care, tropical oncology and meningitis. The department teaches at all levels from postgraduate paediatricians, to medical students, to clinical officers and nurses.
Behzad Nadjm is a clinical researcher based in Muheza, Tanzania. His research interests include community-acquired pneumonia.
Thomas Ngwiri is a paediatrician at Embu Provincial Hospital, Kenya.
