Background After the ebola epidemic, triage systems in many West African hospitals had broken down. This project assessed

the impact of a multi-modal quality improvement intervention based on nurse-led assessment and treatment in a 150-bed tertiary paediatric hospital.

Methods We reorganised patient flow and outpatient department layout. We delivered nurse training based on WHO Emergency Triage Assessment and Treatment (ETAT) guidelines, and intensive mentoring over three months. Responsibility for initial assessment and treatment was shifted to the nursing staff. All patients presenting between 0800 and 1400 were observed for five consecutive days before intervention, and at three and six months following the start of the intervention. The team observed the triage assessments made by the nurses, and compared them to their own assessments. The team also collected data on patient arrival, triage, assessment and treatment times for all patients.

Discussion These results suggest that important improvements to paediatric triage and treatment can be delivered in West African hospitals by nurses working in advanced roles.