A ‘new normal’: Harnessing the experience of COVID-19 for sustained improvements in global emergency care

Mitchell, Rob; Nou, Gary

doi:10.1016/j.lanwpc.2020.100012

Cited by 13 publications

(21 citation statements)

References 5 publications

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“…COVID-19 has illustrated the importance of safe and effective EC, [45][46][47][48] and consistent with the aspirations of global EC providers [13] and the World Health Assembly, [49] there is likely to be increasing demand from LMICs for valid and reliable triage systems. [48] In this context, the present study provides a timely, critical and important review of the IITT. Further research will help clarify its benefits and disadvantages, relative to rapid visual assessment using 'system 1 reasoning' [50] and established tools such as SATS.…”

Section: Discussionmentioning

confidence: 94%

Validation of the Interagency Integrated Triage Tool in a resource-limited, urban emergency department in Papua New Guinea: a pilot study

Mitchell

Bue

Nou

et al. 2021

The Lancet Regional Health - Western Pacific

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Background:The Interagency Integrated Triage Tool (IITT) is a three-tier triage system designed for resource-limited emergency care (EC) settings. This study sought to assess the validity and reliability of a pilot version of the tool in an urban emergency department (ED) in Papua New Guinea.Methods: A pragmatic observational study was conducted at Gerehu General Hospital in Port Moresby, commencing eight weeks after IITT implementation. All ED patients presenting within the subsequent two-month period were included. Triage assessments were performed by a variety of ED clinicians, including community health workers, nurses and doctors. The primary outcome was sensitivity for the detection of time-critical illness, defined by ten pre-specified diagnoses. The association between triage category and ED outcomes was examined using Cramer's V correlation coefficient. Reliability was assessed by inter-rater agreement between a local and an experienced, external triage officer.Findings: Among 4512 presentations during the study period, 58 (1.3%) were classified as category one (emergency), 967 (21.6%) as category two (priority) and 3478 (77.1%) as category three (non-urgent). The tool's sensitivity for detecting the pre-specified set of time-sensitive conditions was 70.8% (95%CI 58.2-81.4%), with negative predictive values of 97.3% (95%CI 96.7 -97.8%) for admission/transfer and 99.9% (95%CI 99.7 -100.0%) for death. The admission/transfer rate was 44.8% (26/58) among emergency patients, 22.9% (223/976) among priority patients and 2.7% (94/3478) among non-urgent patients (Cramer's V = 0.351, p = 0.00). Four of 58 (6.9%) emergency patients, 19/976 (2.0%) priority patients and 3/3478 (0.1%) non-urgent patients died in the ED (Cramer's V = 0.14, p = 0.00). The under-triage rate was 2.7% (94/3477) and the over-triage rate 48.2% (28/58), both within pre-specified limits of acceptability. On average, it took staff 3 minutes 34 seconds (SD 1:06) to determine and document a triage category. Among 70 observed assessments, weighted κ was 0.84 (excellent agreement).

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Section: Discussionmentioning

confidence: 94%

Validation of the Interagency Integrated Triage Tool in a resource-limited, urban emergency department in Papua New Guinea: a pilot study

Mitchell

Bue

Nou

et al. 2021

The Lancet Regional Health - Western Pacific

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“…50 Consistent with the ambitions of the World Health Assembly, 1 demand for valid and reliable triage systems in LMICs is expected to increase. 50 Given that the IITT has been collaboratively developed by WHO, MSF and ICRC, it is likely to be an attractive option for clinicians and policymakers alike.…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, the education programme used to train staff in the system was brief, suggesting that implementation can be achieved at little cost with minimal disruption to clinical services. 35 COVID-19 has illustrated the importance of safe and effective ED care, [47][48][49][50] and the experience of the pandemic has already precipitated improvements in triage functioning. 50 Consistent with the ambitions of the World Health Assembly, 1 demand for valid and reliable triage systems in LMICs is expected to increase.…”

Section: Discussionmentioning

confidence: 99%

“…35 COVID-19 has illustrated the importance of safe and effective ED care, [47][48][49][50] and the experience of the pandemic has already precipitated improvements in triage functioning. 50 Consistent with the ambitions of the World Health Assembly, 1 demand for valid and reliable triage systems in LMICs is expected to increase. 50 Given that the IITT has been collaboratively developed by WHO, MSF and ICRC, it is likely to be an attractive option for clinicians and policymakers alike.…”

Section: Discussionmentioning

confidence: 99%

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Validity and reliability of the Interagency Integrated Triage Tool in a regional emergency department in Papua New Guinea

Mitchell

McKup

Banks

et al. 2021

Emerg Medicine Australasia

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Objective: The Interagency Integrated Triage Tool (IITT) is a novel, three-tier triage system recommended by the World Health Organization. The present study sought to assess the validity and reliability of a pilot version of the tool in a resource-limited ED in regional Papua New Guinea. Methods: This pragmatic prospective observational study, conducted at Mount Hagen Provincial Hospital, commenced 1 month after IITT implementation. The facility did not have a pre-existing triage system. All ED patients presenting within a 5-month period were included. The primary outcome was sensitivity for the detection of time-critical illness, defined by 10 pre-specified diagnoses. The association between triage

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“…[ 11 ] Surprisingly, people worldwide seem to have quickly adapted to the “new normal”, stimulated by the pandemic, through regular sanitization, maintaining social distance, quarantining, and using personal protective equipment (PPE) as recommended by the WHO. [ 12,13 ]…”

Section: Introductionmentioning

confidence: 99%

3D‐Printing to Mitigate COVID‐19 Pandemic

Kumar

Pumera

2021

Adv Funct Materials

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3D-printing technology provided numerous contributions to the health sector during the recent Coronavirus disease 2019 (COVID-19) pandemic. Several of the 3D-printed medical devices like personal protection equipment (PPE), ventilators, specimen collectors, safety accessories, and isolation wards/ chambers were printed in a short time as demands for these were rising significantly. The review discusses some of these contributions of 3D-printing that helped to protect several lives during this health emergency. By enlisting some of the significant benefits of using the 3D-printing technique during an emergency over other conventional methods, this review claims that the former opens enormous possibilities in times of serious shortage of supply and exceeding demands. This review acknowledges the collaborative approaches adopted by individuals, entrepreneurs, academicians, and companies that helped in forming a global network for delivering 3D-printed medical/non-medical components, when other supply chains were disrupted. The collaboration of the 3D-printing technology with the global health community unfolds new and significant opportunities in the future.

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A ‘new normal’: Harnessing the experience of COVID-19 for sustained improvements in global emergency care

Cited by 13 publications

References 5 publications

Validation of the Interagency Integrated Triage Tool in a resource-limited, urban emergency department in Papua New Guinea: a pilot study

Validation of the Interagency Integrated Triage Tool in a resource-limited, urban emergency department in Papua New Guinea: a pilot study

Validity and reliability of the Interagency Integrated Triage Tool in a regional emergency department in Papua New Guinea

3D‐Printing to Mitigate COVID‐19 Pandemic

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