Regional scale-up of an Emergency Triage Assessment and Treatment (ETAT) training programme from a referral hospital to primary care health centres in Guatemala

Kapoor, Rupa; Sandoval, Maria Antonieta; Avendaño, Leslie; Cruz, Andrea T.; Soto, Miguel A. Valdez; Camp, Elizabeth A.; Crouse, Heather L.

doi:10.1136/emermed-2015-205057

Cited by 17 publications

(20 citation statements)

References 16 publications

(10 reference statements)

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“…The 2016 global EM articles selected for full review are listed in Table 4. [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] Nineteen articles were selected for inclusion, of which 15 (79%) were categorized as emergency care, three (16%) were categorized as development, and one (5%) was categorized as disaster response articles. Eighteen (95%) articles were original research manuscripts and one (5%) was a review article.…”

Section: Resultsmentioning

confidence: 99%

“…A two-staged triage system was implemented in Cambodia by Khan et al 22 to separate critical, urgent, and nonurgent patients, demonstrating moderate validity and inter-rater reliability. The use of the Emergency Triage Assessment and Treatment (ETAT) tool for pediatric patients continues to spread, with Kapoor et al 33 demonstrating the dissemination of ETAT from the referral hospitals down to the primary health center level in Guatemala. In Nigeria, Burnham-Marusich et al 18 used a nested design to conduct two-step screening for sickle cell disease, which due to pain crises and acute infections poses a heavy burden on the emergency care system in sub-Saharan Africa.…”

Section: Plos Onementioning

confidence: 99%

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Global Emergency Medicine: A Review of the Literature From 2016

Becker

Hansoti

Bartels

et al. 2017

Academic Emergency Medicine

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Objectives: The Global Emergency Medicine Literature Review (GEMLR) conducts an annual search of peerreviewed and gray literature relevant to global emergency medicine (EM) to identify, review, and disseminate the most important new research in this field to a global audience of academics and clinical practitioners.Methods: This year 13,890 articles written in four languages were identified by our search. These articles were distributed among 20 reviewers for initial screening based on their relevance to the field of global EM. An additional two reviewers searched the gray literature. All articles that were deemed appropriate by at least one reviewer and approved by their editor underwent formal scoring of overall quality and importance. Two independent reviewers scored all articles.Results: A total of 716 articles met our inclusion criteria and underwent full review. Fifty-nine percent were categorized as emergency care in resource-limited settings, 17% as EM development, and 24% as disaster and humanitarian response. Nineteen articles received scores of 18.5 or higher out of a maximum score of 20 and were selected for formal summary and critique. Inter-rater reliability testing between reviewers revealed Cohen's kappa of 0.441. Conclusions:In 2016, the total number of articles identified by our search continued to increase. The proportion of articles in each of the three categories remained stable. Studies and reviews with a focus on infectious diseases, pediatrics, and the use of ultrasound in resource-limited settings represented the majority of articles selected for final review. identify and consolidate the relevant global EM literature into a format that is readily available to academics and practitioners. [1][2][3][4][5][6][7][8][9][10][11] This year, our panel of reviewers and editors included physicians from Canada, Ethiopia, Ghana, Singapore, and the United States. T he Global EmergencyOur group strives to identify the most relevant practice changing articles, by scouring both the peerreviewed and gray literature via a comprehensive search strategy. Gray literature has been defined as any material produced by an organization whose primary function is not peer-reviewed academic publication. 12Our goal in performing a gray literature search is to identify new global EM research conducted by government agencies, local or international nongovernmental organizations, or other entities that may not have published in peer-reviewed journals.The primary goals of the review are to illustrate best practices, stimulate research, and promote further professionalization in the field of global EM through the identification of important new publications that focus on emergency care in the global context, including care provision in limited-resource settings, disaster and humanitarian response, and the development of EM as a clinical discipline throughout the world. At the same time, it is important to note that this review is not a formal systematic review or meta-analysis, as it does not aim to synthesize th...

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Section: Resultsmentioning

confidence: 99%

Section: Plos Onementioning

confidence: 99%

Global Emergency Medicine: A Review of the Literature From 2016

Becker

Hansoti

Bartels

et al. 2017

Academic Emergency Medicine

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“…21-23 Previously, we developed and implemented a locally led, self-sustaining, high-quality, and effective Spanish version of the WHO Emergency Triage Assessment and Treatment (ETAT) program (Clasificación, Evaluación y Tratamiento de Emergencias Pediátricas [CETEP]). 21 Since then HNPB has implemented a formal CETEP training program for pediatric personnel and triage process in the pediatric emergency department (PED) that has reduced admission rates, length of stay, and mortality.…”

Section: Introductionmentioning

confidence: 99%

“…22 Leaders at HNPB self-identified the next step in the quality improvement initiative as standardization and improvement of the referral/counter-referral system with primary health centers (PHCs) alongside extension of CETEP trainings to pediatric personnel in the PHCs within their region in Guatemala. 23 …”

Section: Introductionmentioning

confidence: 99%

Initiating a Standardized Regional Referral and Counter-Referral System in Guatemala: A Mixed-Methods Study

Kapoor

Avendaño²,

Sandoval³

et al. 2017

Global Pediatric Health

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Background:Few data exist for referral processes in resource-limited settings. We utilized mixed-methods to evaluate the impact of a standardized algorithm and training module developed for locally identified needs in referral/counter-referral procedures between primary health centers (PHCs) and a Guatemalan referral hospital. Methods: PHC personnel and hospital physicians participated in surveys and focus groups pre-implementation and 3, 6, and 12 months post-implementation to evaluate providers’ experience with the system. Referred patient records were reviewed to evaluate system effectiveness. Results: A total of 111 initial focus group participants included 96 (86.5%) from PHCs and 15 from the hospital. Of these participants, 53 PHC physicians and nurses and 15 hospital physicians initially completed written surveys. Convenience samples participated in follow-up. Eighteen focus groups achieved thematic saturation. Four themes emerged: effective communication; provision of timely, quality patient care with adequate resources; educational opportunities; and development of empowerment and relationships. Pre- and post-implementation surveys demonstrated significant improvement at the PHCs (P < .001) and the hospital (P = .02). Chart review included 435 referrals, 98 (22.5%) pre-implementation and 337 (77.5%) post-implementation. There was a trend toward an increased percentage of appropriately referred patients requiring medical intervention (30% vs 40%, P = .08) and of patients requiring intervention who received it prior to transport (55% vs 73%, P = .06). Conclusions: Standardizing a referral/counter-referral system improved communication, education, and trust across different levels of pediatric health care delivery. This model may be used for extension throughout Guatemala or be modified for use in other countries. Mixed-methods research design can evaluate complex systems in resource-limited settings.

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“…The EMJ paper by Kapoor et al 8 describes how they used the ETAT course for primary health centre staff in Latin America. They translated the course into Spanish (CETEP Clasificación, Evaluación y Tratamiento de Emergencias Pediátricas) and adapted it to local conditions and national guidelines in conjunction with the Ministry of Health.…”

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confidence: 99%