An integrated approach to emergency triage assessment and treatment in Uganda

Abstract

Background: Reducing mortality among patients who present to primary referral facilities in need of emergency care requires efficient triage and immediate correct management known more commonly as Emergency Triage, Assessment and Treatment (ETAT). Integrated Management of Infectious Disease (IMID) training and on-site support (OSS) have been the tools used to build capacity among mid-level practitioners who have been found to be lacking in ETAT skills in the region.

Objective: To investigate the use of Integrated Management of Infectious Disease (IMID) training and on-site support (OSS) tools to improve ETAT in health care facilities in rural Uganda.

Design: Randomized mixed methods evaluation.

Setting: Thirty-six facilities in Uganda were randomized 1:1 to arm A (IMID and OSS) and arm B (IMID alone).

Subjects: Two mid-level practitioners, (clinical officers or senior nurses), from each facility participated in offsite IMID training. Staff at 18 facilities in arm A participated in OSS (two days each month of outreach and quality improvement for nine months).

Results: Time series data on facility performance of three ETAT indicators were compared over 14 months and data on mortality among pediatric inpatients were compared across arms. Improvements differed across facilities and indicators, but steady improvement in triage occurred in arm A, with convergence across arms in the management of emergency patients. Analysis of baseline indicators and improvements demonstrated that facilities could improve their performance regardless of their starting point.

Conclusion: IMID and OSS both improved the management of patients with an acute illness presenting to rural health facilities.