Objective. To validate a revised version of the paediatric South African Triage Scale (SATS) against admission as a reference standard and compare the sensitivity of triage using: (i) clinical discriminators; (ii) an age-appropriate physiological composite score; and (iii) a combination of both. Methods. A prospective cohort study was undertaken validating the revised paediatric SATS against outcome markers of children at six emergency centres during a 2-month period in 2011. The primary outcome marker was the proportion of children admitted. Validity indicators including sensitivity (Se), specificity, positive predictive value and negative predictive value (NPV) were used to estimate the validity. Associated percentages for over-/under-triage were used to further assess practical application of the paediatric SATS. Results. A total of 2 014 children were included. The percentage of hospital admissions increased with an increase in the level of urgency from 5% in the non-urgent patients to 73% in the emergency patients. The data demonstrated that sensitivity increased substantially when using the SATS, which is a combination of clinical discriminators and the Triage Early Warning Score (TEWS) (Se 91.0%, NPV 95.3%), compared with use of clinical discriminators in isolation (Se 57.1%, NPV 86.3%) or the TEWS in isolation (Se 75.6%, NPV 89.1%). Conclusion. The results of this study illustrate that the revised paediatric SATS is a safe and robust triage tool.

There is growing interest in studying processes of human sensemaking, as this strongly influences human and organizational behavior as well as complex system dynamics due to the diverse lenses people use to interpret and act in the world. The Cognitive Edge SenseMaker® tool is one method for capturing and making sense of people’s attitudes, perceptions, and experiences. It is used for monitoring and evaluation; mapping ideas, mind-sets, and attitudes; and detecting trends and weak signals. However, academic literature describing the tool-set and method is lacking. This introduction aims to guide researchers in choosing when to use SenseMaker and to facilitate understanding of its execution and limitations. SenseMaker can provide nuanced insight into system-level patterns of human sensemaking that can provide insight to nudge systems towards more desirable futures, and enable researchers to measure beyond what they know.

Creating community education initiatives, strengthening the formal prehospital emergency care system, implementing triage in healthcare facilities and training healthcare providers in emergency care were community-identified and provider-identified solutions for improving access to emergency care.

Nurses are the largest group of healthcare workers in Africa. By adequately equipping nurses to identify, intervene and care for emergency conditions, emergency healthcare systems can be strengthened. To address this need, a nursing working group was formed within the African Federation for Emergency Medicine (AFEM). The aim of this international emergency nursing group was to develop a guiding document to help improve emergency nursing skills within Africa. Using this guiding document, a group of Tanzanian clinical nurse trainers was selected to develop a context specific short course. They used this guiding document as a foundation to improve skill development. The pilot course was well received and has since expanded to training in five regions within the United Republic of Tanzania. The clinical nurse trainers leading the course, are supported by a mentorship programme with competent educators within a global emergency nursing infrastructure. This course, a combination of local knowledge, formal mentorship programs, and international nursing support, demonstrates that investing in the improvement of emergency nursing skills can have high impact results with low-cost. This will ultimately improve emergency care on the continent.

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ObjectivesCommunity members are often the first to witness and respond to medical and traumatic emergencies, making them an essential first link to emergency care systems. The Emergency First Aid Responder (EFAR) programme is short course originally developed to help South Africans manage emergencies at the community level, pending arrival of formal care providers. EFAR was implemented in two rural regions of Zambia in 2015, but no changes were originally made to tailor the course to the new setting. We undertook this study to identify potential refinements in the original EFAR curriculum, and to adapt it to the local context in Zambia.DesignThe EFAR curriculum was mapped against available chief complaint data. An expert group used information from the map, in tandem with personal knowledge, to rank each course topic for potential impact on patient outcomes and frequency of use in practice. Individual blueprints were compiled to generate a refined EFAR curriculum, the time breakdown of which reflects the relative weight of each topic.SettingThis study was conducted based on data collected in Kasama, a rural region of Zambia’s Northern Province.ParticipantsAn expert group of five physicians practising emergency medicine was selected; all reviewers have expertise in the Zambian context, EFAR programme and/or curriculum development.ResultsThe range of emergencies that Zambian EFARs encounter indicates that the course must be broad in scope. The refined curriculum covers 54 topics (seven new) and 25 practical skills (five new). Practical and didactic time devoted to general patient care and scene management increased significantly, while time devoted to most other clinical, presentation-based categories (eg, trauma care) decreased.ConclusionsDiscrepancies between original and refined curricula highlight a mismatch between the external curriculum and local context. Even with limited data and resources, curriculum mapping and blueprinting are possible means of resolving these contextual issues.

Background Emergency Departments serve as a main entry point for patients into hospitals, and the team, the core of which is formed by doctors and nurses needs to make sense of and respond to the constant flux of information. This requires sense-making, communication, and collaborative operational decision-making. The study’s main aim was to explore how collective, interprofessional sense-making occurs in the emergency department. Collective sense-making is deemed a precursor for adaptive capability, which, in turn, promotes coping in a dynamically changing environment. Method Doctors and nurses working in five large state emergency departments in Cape Town, South Africa, were invited to participate. Using the SenseMaker® tool, a total of 84 stories were captured over eight weeks between June and August 2018. Doctors and nurses were equally represented. Once participants shared their stories, they self-analysed these stories within a specially designed framework. The stories and self-codified data were analysed separately. Each self-codified data point was plotted in R-studio and inspected for patterns, after which the patterns were further explored. The stories were analysed using content analysis. The SenseMaker® software allows switching between quantitative (signifier) and qualitative (descriptive story) data during interpretation, enabling more deeply nuanced analyses. Results The results focused on four aspects of sense-making, namely views on the availability of information, the consequences of decisions (actions), assumptions regarding appropriate action, and preferred communication methods. There was a noticeable difference in what doctors and nurses felt would constitute appropriate action. The nurses were more likely to act according to rules and policies, whereas the doctors were more likely to act according to the situation. More than half of the doctors indicated that they found it best to communicate informally, whereas the nurses indicated that formal communication worked best for them. Conclusion This study was the first to explore the ED’s interprofessional team’s adaptive capability to respond to situations from a sense-making perspective. We found an operational disconnect between doctors and nurses caused by asymmetric information, disjointed decision-making approaches, differences in habitual communication styles, and a lack of shared feedback loops. By cultivating their varied sense-making experiences into one integrated operational foundation with stronger feedback loops, interprofessional teams’ adaptive capability and operational effectiveness in Cape Town EDs can be improved.