Implementation of ETAT (Emergency Triage Assessment And Treatment) in a central hospital in malawi

Robison, Jeff A.; ahmed, Zeinab Mohammed Ibrahim; Durand, Charlotte; Nosek, Carl A; Namathanga, Annie; Milazi, Robert; Thomas, Alain; Mwansambo, Charles; Kazembe, Peter N.; Torrey, Susan

doi:10.1136/adc.2011.212563.174

Cited by 15 publications

(15 citation statements)

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“…; Robinson et al . ). Therefore, increased clinical evaluations on the wards should also lead to improved patient mortality.…”

Section: Discussionmentioning

confidence: 97%

“…A rapid response team at KCH, and most children's hospitals in southern Africa, is not feasible given severe resource limitations. However, many clinicians and nurses are trained in traditional ETAT [five clinicians and 24 nurses at KCH during this study (Namathanga 2011)], which includes resuscitation skills and IMCI-based treatment decisions (Robertson & Molyneux 2001;Molyneux et al 2006;Robinson et al 2011). Therefore, increased clinical evaluations on the wards should also lead to improved patient mortality.…”

Section: Discussionmentioning

confidence: 99%

“…; Robinson et al . ). Despite this important contribution, many gaps remain for optimising paediatric inpatient care.…”

Section: Introductionmentioning

confidence: 97%

“…Emergency triage, assessment and treatment (ETAT) (Gove et al 1999), a component of the WHO Integrated Management of Childhood Illness (IMCI) programme (WHO 2005), is a validated triage tool providing simplified, symptom-based guidelines that can reduce overall hospital mortality when used at admission. ETAT is widely accepted as a centrepiece for delivering quality paediatric hospital care in developing countries (Robertson & Molyneux 2001;Molyneux et al 2006;Robinson et al 2011). Despite this important contribution, many gaps remain for optimising paediatric inpatient care.…”

Section: Introductionmentioning

confidence: 99%

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Task shifting an inpatient triage, assessment and treatment programme improves the quality of care for hospitalised Malawian children

Olson

Preidis

Milazi

et al. 2013

Tropical Med Int Health

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Objective We aimed to improve pediatric inpatient surveillance at a busy referral hospital in Malawi with 2 new programs: (1) the provision of vital sign equipment and implementation of an inpatient triage program (ITAT) that includes a simplified pediatric severity-of-illness score; (2) task-shifting ITAT to a new cadre of health care workers called “Vital Sign Assistants” (VSAs). Methods This study, conducted on the pediatric inpatient ward of a large referral hospital in Malawi, was divided into 3 phases, each lasting 4 weeks. In Phase A, we collected baseline data. In Phase B, we provided 3 new automated vital sign poles and implemented ITAT with current hospital staff. In Phase C, VSAs were introduced and performed ITAT. Our primary outcome measures were the number of vital sign assessments performed and clinician notifications to reassess patients with high ITAT scores. Results We enrolled 3,994 patients who received 5,155 vital sign assessments. Assessment frequency was equal between Phases A (0.67 assessments/patient) and B (0.61 assessments/patient), but increased 3.6-fold in Phase C (2.44 assessments/patient, p<0.001). Clinician notifications increased from Phases A (84) and B (113) to Phase C (161, p=0.002). Inpatient mortality fell from Phase A (9.3%) to Phases B (5.7) and C (6.9%). Conclusions ITAT with VSAs improved vital sign assessments and nearly doubled clinician notifications of patients needing further assessment due to high ITAT scores, while equipment alone made no difference. Task-shifting ITAT to VSAs may improve outcomes in pediatric hospitals in the developing world.

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“…; Robinson et al . ). Therefore, increased clinical evaluations on the wards should also lead to improved patient mortality.…”

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

“…; Robinson et al . ). Despite this important contribution, many gaps remain for optimising paediatric inpatient care.…”

Section: Introductionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Task shifting an inpatient triage, assessment and treatment programme improves the quality of care for hospitalised Malawian children

Olson

Preidis

Milazi

et al. 2013

Tropical Med Int Health

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“…; Robinson et al . ), once patients are admitted to the inpatient ward, no further formalised surveillance system exists to provide continued monitoring and timely clinical intervention. As a result, students, nurses and other junior healthcare workers are tasked with identifying deteriorating ward patients in often overcrowded facilities despite limited expertise.…”

Section: Introductionmentioning

confidence: 99%

Development of a severity of illness scoring system (inpatient triage, assessment and treatment) for resource‐constrained hospitals in developing countries

Olson

Davis

Milazi

et al. 2013

Tropical Med Int Health

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Objective To develop a new pediatric illness severity score, called Inpatient Triage, Assessment, and Treatment (ITAT), for resource-limited settings to identify hospitalized patients at highest risk of death and facilitate urgent clinical re-evaluation. Methods We performed a nested case-control study at a Malawian referral hospital. The ITAT score was derived from 4 equally-weighted variables, yielding a cumulative score between 0 and 8. Variables included oxygen saturation, temperature, and age-adjusted heart and respiratory rates. We compared the ITAT score between cases (deaths) and controls (discharges) in predicting death within 2 days. Our analysis includes predictive statistics, bivariable and multivariable logistic regression, and calculation of data-driven scores. Results A total of 54 cases and 161 controls were included in the analysis. The area under the receiver operating characteristic curve was 0.76. At an ITAT cutoff of 4, the sensitivity, specificity, and likelihood ratio were 0.44, 0.86, and 1.70, respectively. A cumulative ITAT score of 4 or higher was associated with increased odds of death (OR: 4.80; 95% CI: 2.39 – 9.64). A score of 2 for all individual vital signs was a statistically significant independent predictor of death. Conclusions We developed an inpatient triage tool (ITAT) appropriate for resource-constrained hospitals that identifies high-risk children after hospital admission. Further research is needed to study how best to operationalize ITAT in developing countries.

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Providing Neurocritical Care in Resource-Limited Settings: Challenges and Opportunities

et al. 2022

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Implementation of ETAT (Emergency Triage Assessment And Treatment) in a central hospital in malawi

Cited by 15 publications

References 0 publications

Task shifting an inpatient triage, assessment and treatment programme improves the quality of care for hospitalised Malawian children

Task shifting an inpatient triage, assessment and treatment programme improves the quality of care for hospitalised Malawian children

Development of a severity of illness scoring system (inpatient triage, assessment and treatment) for resource‐constrained hospitals in developing countries

Providing Neurocritical Care in Resource-Limited Settings: Challenges and Opportunities

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