<scp>COVID</scp>
            ‐19 and the Indo–Pacific: implications for resource‐limited emergency departments

Woodruff, Isobelle G; Mitchell, Rob; Phillips, Georgina; Sharma, Deepak; Toito'ona, Patrick; Jayasekera, Krishantha; Wah, Khine Shwe; Cox, Megan; O’Reilly, Gerard

doi:10.5694/mja2.50750

Cited by 16 publications

(25 citation statements)

References 14 publications

(43 reference statements)

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“…For participants and HCWs at the frontline, the evolving COVID-19 crisis amplified the well-known need for long-term strategy and meaningful investment in the training and building of human resources for health on the terms of Pacific HCWs (Theme 5). 3 , 31 Iterative strengthening of local EC skills (clinical and non-clinical) to work within interfacing health services and systems (multi-level, multi-sectoral and inter-generational) is especially needed. The COVID-19 experience has reinforced the urgent need to train, support, retain, reward and integrate EC staff in all Pacific health systems ( Box 2 ).…”

Section: Discussionmentioning

confidence: 99%

“…First, the complex challenges already facing the chronically understaffed EC and broader health workforce in the region was known at study commencement in March 2020. 2 , 3 , 31 Therefore, the research team did not want a deficit approach taken that grounded study investigation in the pre-existing insufficient HCW numbers and poor patient-doctor ratios. Rather, we aimed to illuminate the voices, competency, ingenuity, responsiveness, and productivity of the highly committed HCWs at the fore of the Pacific region's COVID-19 pandemic response.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Lessons from the frontline: The COVID-19 pandemic emergency care experience from a human resource perspective in the Pacific region

Brolan

Körver

Phillips

et al. 2022

The Lancet Regional Health - Western Pacific

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Lessons from the frontline: The COVID-19 pandemic emergency care experience from a human resource perspective in the Pacific region

Brolan

Körver

Phillips

et al. 2022

The Lancet Regional Health - Western Pacific

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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.…”

Section: Discussionmentioning

confidence: 99%

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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“…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%

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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COVID ‐19 and the Indo–Pacific: implications for resource‐limited emergency departments

Cited by 16 publications

References 14 publications

Lessons from the frontline: The COVID-19 pandemic emergency care experience from a human resource perspective in the Pacific region

Lessons from the frontline: The COVID-19 pandemic emergency care experience from a human resource perspective in the Pacific region

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

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