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Abstract
Introduction A key component of the World Health Organisation’s ETAT+ (emergency triage, assessment and treatment) guidance is triage. Early identification of sick children as soon as possible after arrival in the health facility with prompt treatment reduces morbidity and mortality. Triage at this District Hospital in Kenya is performed at the customer care desk by a non-healthcare worker without any formal training.
Aim To determine if it is feasible to institute triage successfully in a Kenyan District General Hospital where there is no formal triage mechanism or trained healthcare worker seeing patients at the point of entry.
Methods A prospective audit of triage by the customer care worker over a two month period in June–July 2015. A modified ETAT+ triage system was used as the gold standard. The customer care worker was directly observed triaging all patients under the age of 5 years self-presenting to the hospital during a weekday morning period. His performance was re-evaluated after an initial training session and again after a final training session. Training sessions took the form of demonstration and supervision over a half day period, along with printed poster material for easy reference.
Results Before training, 47 children under 5 years were observed. 1/47 (2%) were asked about their presenting complaint, 0/47 (0%) had a physical assessment for priority or emergency signs. After the initial training, 15/39 (38%) of eligible patients were fully assessed and correctly triaged. After a second training session, this increased to 23/36 (64%).
Conclusion The role of triage is to identify important signs and direct the sick patient to the most appropriate place for immediate treatment. Diagnosis and management of medical conditions is not the remit of the triage person. In a low-resource setting where trained healthcare workers are at a premium, this audit shows that it may be possible to use non-healthcare workers to deliver effective triage with sufficient training. However, a modified triage system is needed to account for the lack of equipment and healthcare training. In addition, observer bias may have affected results.