Harnessing inter-disciplinary collaboration to improve emergency care in low- and middle-income countries (LMICs): results of research prioritisation setting exercise

Lecky, Fiona; Reynolds, Teri; Olubukola, Otesile; Hollis, Sara; Turner, Janette; Fuller, Gordon; Sammy, Ian; Williams-Johnson, J; Geduld, Heike; Tenner, Andrea G.; French, Simone; Govia, Ishtar; Balen, Julie; Goodacre, Steve; Marahatta, Sujan Babu; DeVries, Shaheem; Sawe, Hendry R.; El-Shinawi, Mohamed; Mfinanga, Juma A.; Rubiano, Andrés M.; Chebbi, Henda; Shin, Sang Do; Haddadi, Mashyaneh; Firew, Tsion; Taubert, Kathryn A.; Lee, Andrew; Convocar, Pauline; Jamaluddin, Sabariah Faizah; Kotecha, Shahzmah; Yaqeen, Emad Abu; Wells, Katie; Wallis, Lee

doi:10.1186/s12873-020-00362-7

Cited by 19 publications

(19 citation statements)

References 37 publications

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“…This compromises the precision of the findings, but reflects the real-world challenges of data capture and clinical research in resource-limited ED settings. [30] It is also consistent with the methodological challenges reported in other LMIC triage studies. [ 6 , 29 , 30] Third, outcome measures related to mortality only included patients who died in the ED, and additional deaths may have occurred shortly after departure.…”

Section: Discussionsupporting

confidence: 87%

“… [30] It is also consistent with the methodological challenges reported in other LMIC triage studies. [ 6 , 29 , 30] Third, outcome measures related to mortality only included patients who died in the ED, and additional deaths may have occurred shortly after departure. Finally, in comparing the performance of the IITT with other triage instruments, it should be recognised that the sensitivity of a three-tier system is intrinsically likely to be higher than a four-tier or five-tier system.…”

Section: Discussionsupporting

confidence: 87%

“…In light of the contextual and methodological variation in the literature, [ 1 , 4 , 5 , 29] triage has been identified as a priority area for global EC research. [ 30 , 31] …”

Section: Introductionmentioning

confidence: 99%

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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: Discussionsupporting

confidence: 87%

Section: Discussionsupporting

confidence: 87%

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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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“…Delays in utilization of available EC are widely recognized though not well understood, ranking second among 7 priority research questions identified to facilitate the improvement of EC in LMICs through a research priority setting exercise conducted by a multidisciplinary coalition of researchers and stakeholders, the Global Emergency Care Research Network [4].…”

Section: Introductionmentioning

confidence: 99%

Getting to the Emergency Department in Time: Interviews With Patients and Their Caregivers on the Challenges to Emergency Care Utilization in Rural Uganda - a Grounded Theory Approach

Pickering

Dreifuss

Ndyamwijuka³

et al. 2021

Preprint

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Objectives Karoli Lwanga Hospital and Global Emergency Care, a 501(c)(3) nongovernmental organization, operate an Emergency Department (ED) in Uganda's rural Rukungiri District. Despite available emergency care (EC), preventable death and disability persist due to delayed patient presentations. Implementation of effective EC requires assessment of socioeconomic, cultural, and structural factors leading to treatment delay. Methods We purposefully sampled and interviewed patients and caregivers presenting to the ED more than 12 hours after onset of chief complaint in January-March 2017 to include various ages, genders, and complaints. Semistructured interviews addressing actions taken before seeking EC and delays to presentation once the need for EC was recognized were conducted. Interviews were audio recorded, translated, and transcribed, enabling the interdisciplinary and multicultural research team to conduct thematic analysis utilizing a grounded theory approach. Results The 50 ED patients for whom care was sought (mean age 33) had approximately even distribution of gender, as well as occupation (none, subsistence farmers and small business owner). Interviews were conducted with 37 caregivers and 13 ED patients. The majority of interviewees (mean age 38 years) were women with a primary education. The median duration of patients' chief complaint on ED presentation was 5.5 days. On average, participants identified severe symptoms necessitating EC 1 day before presentation. Four themes of treatment delay before and after severity were recognized were identified: 1) Cultural factors and limited knowledge of emergency signs and initial actions to take ; 2) Use of local health facilities despite perception of inadequate services; 3) Lack of resources to cover the anticipated cost of obtaining EC; 4) Inadequate transportation options. Conclusions Interventions are warranted to address each of the four major reasons for treatment delay. The next stage of formative research will generate intervention strategies and assess the opportunities and challenges to implementation with community and health system stakeholders.

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“…These studies also revealed that enhancing interdisciplinary collaboration and prioritization of the problem enhance emergency care coverage. 6,7 In Africa very little is known about pre-hospital emergency nursing care. Inadequate emergency nursing care, including prehospital pain management often attributed due to lack of knowledge, lack of resources, and poor assessment skills particularly in low-and middle-income countries.…”

Section: Introductionmentioning

confidence: 99%

Knowledge, Practice, and Associated Factors of Nurses in Pre-Hospital Emergency Care at a Tertiary Care Teaching Hospital

Abate¹,

Mekonnen²

2020

OAEM

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Harnessing inter-disciplinary collaboration to improve emergency care in low- and middle-income countries (LMICs): results of research prioritisation setting exercise

Cited by 19 publications

References 37 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

Getting to the Emergency Department in Time: Interviews With Patients and Their Caregivers on the Challenges to Emergency Care Utilization in Rural Uganda - a Grounded Theory Approach

Knowledge, Practice, and Associated Factors of Nurses in Pre-Hospital Emergency Care at a Tertiary Care Teaching Hospital

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