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Mitchell R, Fang W, Tee QW, O'Reilly G, Romero L, Mitchell R, Bornstein S, Cameron P. Systematic review: What is the impact of triage implementation on clinical outcomes and process measures in low- and middle-income country emergency departments? Acad Emerg Med 2024; 31:164-182. [PMID: 37803524 DOI: 10.1111/acem.14815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 09/15/2023] [Accepted: 09/19/2023] [Indexed: 10/08/2023]
Abstract
INTRODUCTION Triage is widely regarded as an essential function of emergency care (EC) systems, especially in resource-limited settings. Through a systematic search and review of the literature, we investigated the effect of triage implementation on clinical outcomes and process measures in low- and middle-income country (LMIC) emergency departments (EDs). METHODS Structured searches were conducted using MEDLINE, CENTRAL, EMBASE, CINAHL, and Global Health. Eligible articles identified through screening and full-text review underwent risk-of-bias assessment using the Newcastle-Ottawa Scale. The quality of evidence for each effect measure was summarized using GRADE. RESULTS Among 10,394 articles identified through the search strategy, 58 underwent full-text review and 16 were included in the final synthesis. All utilized pre-/postintervention methods and a majority were single center. Effect measures included mortality, waiting time, length of stay, admission rate, and patient satisfaction. Of these, ED mortality and time to clinician assessment were evaluated most frequently. The majority of studies using these outcomes identified a positive effect, namely a reduction in deaths and waiting time among patients presenting for EC. The quality of the evidence was moderate for these measures but low or very low for all other outcomes and process indicators. CONCLUSIONS There is moderate quality of evidence supporting an association between the introduction of triage and a reduction in deaths and waiting time. Although the available data support the value of triage in LMIC EDs, the risk of confounding and publication bias is significant. Future studies will benefit from more rigorous research methods.
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Affiliation(s)
- Rob Mitchell
- Alfred Health, Melbourne, Victoria, Australia
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Wendy Fang
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Qiao Wen Tee
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Gerard O'Reilly
- Alfred Health, Melbourne, Victoria, Australia
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | | | | | | | - Peter Cameron
- Alfred Health, Melbourne, Victoria, Australia
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Hugo JFM, Maimela TCR, Janse van Rensburg MNS, Heese J, Nakazwa CE, Marcus TS. The three-stage assessment to support hospital-home care coordination in Tshwane, South Africa. Afr J Prim Health Care Fam Med 2020; 12:e1-e10. [PMID: 32634020 PMCID: PMC7433246 DOI: 10.4102/phcfm.v12i1.2385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 04/20/2020] [Accepted: 05/07/2020] [Indexed: 11/06/2022] Open
Abstract
Background In complex health settings, care coordination is required to link patients to appropriate and effective care. Although articulated as system and professional values, coordination and cooperation are often absent within and across levels of service, between facilities and across sectors, with negative consequences for clinical outcomes as well as service load. Aim This article presents the results of an applied research initiative to facilitate the coordination of patient care. Setting The study took place at three hospitals in the sub-district 3 public health complex (Tshwane district). Method Using a novel capability approach to learning, interdisciplinary, clinician-led teams made weekly coordination-of-care ward rounds to develop patient-centred plans and facilitate care pathways for patients identified as being stuck in the system. Notes taken during three-stage assessments were analysed thematically to gain insight into down referral and discharge. Results The coordination-of-care team assessed 94 patients over a period of six months. Clinical assessments yielded essential details about patients’ varied and multimorbid conditions, while personal and contextual assessments highlighted issues that put patients’ care needs and possibilities into perspective. The team used the combined assessments to make patient-tailored action plans and apply them by facilitating cooperation through interprofessional and intersectoral networks. Conclusion Effective patient care-coordination involves a set of referral practices and processes that are intentionally organised by clinically led, interprofessional teams. Empowered by richly informed plans, the teams foster cooperation among people, organisations and institutions in networks that extend from and to patients. In so doing, they embed care coordination into the discharge process and make referral to a link-to-care service.
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Affiliation(s)
- Jannie F M Hugo
- Department of Family Medicine, Faculty of Health Sciences, University of Pretoria, Tshwane COPC Research Unit, Faculty of Health Sciences, University of Pretoria, Tshwane.
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Swart AT, Muller CE, Rabie T. The role of triage to reduce waiting times in primary health care facilities in the North West province of South Africa. Health SA 2018; 23:1097. [PMID: 31934386 PMCID: PMC6917407 DOI: 10.4102/hsag.v23i0.1097] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 07/09/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Worldwide, patients visiting health care facilities in the public health care sector have to wait for attention from health care professionals. In South Africa, the Cape Triage Score system was implemented successfully in hospitals' emergency departments in the Cape Metropole. The effective utilisation of triage could improve the flow of primary health care (PHC) patients and direct the patients to the right health care professional immediately. AIM No literature could be traced on the implementation of triage in PHC facilities in South Africa. Consequently, a study addressing this issue could address this lack of information, reduce waiting times in PHC facilities and improve the quality of care. SETTING PHC facilities in a sub-district of the North West province of South Africa. METHOD A quantitative, exploratory, typical descriptive pre-test-post-test design was used. The study consisted of two phases. During phase 1, the waiting time survey checklist was used to determine the baseline waiting times. In phase 2, the Cape Triage Score system that triaged the patients and the waiting time survey checklist were used. RESULTS Data were analysed using Cohen's effect sizes by comparing the total waiting times obtained in both phases with the waiting time survey checklist. Results indicated no reduction in the overall waiting time; however, there was a practical significance where triage was applied. Referral was much quicker to the correct health professional and to the hospitals. CONCLUSION Although the results indicated no reduction in the overall waiting time of patients, structured support systems and triage at PHC facilities should be used to make referral quicker to the correct health professional and to the hospitals.
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Affiliation(s)
| | | | - Tinda Rabie
- School of Nursing Science, North-West University, South Africa
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Gile PP, Buljac-Samardzic M, Klundert JVD. The effect of human resource management on performance in hospitals in Sub-Saharan Africa: a systematic literature review. HUMAN RESOURCES FOR HEALTH 2018; 16:34. [PMID: 30068356 PMCID: PMC6090989 DOI: 10.1186/s12960-018-0298-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 07/09/2018] [Indexed: 05/26/2023]
Abstract
Hospitals in Sub-Saharan Africa (SSA) face major workforce challenges while having to deal with extraordinary high burdens of disease. The effectiveness of human resource management (HRM) is therefore of particular interest for these SSA hospitals. While, in general, the relationship between HRM and hospital performance is extensively investigated, most of the underlying empirical evidence is from western countries and may have limited validity in SSA. Evidence on this relationship for SSA hospitals is scarce and scattered. We present a systematic review of empirical studies investigating the relationship between HRM and performance in SSA hospitals.Following the PRISMA protocol, searching in seven databases (i.e., Embase, MEDLINE, Web of Science, Cochrane, PubMed, CINAHL, Google Scholar) yielded 2252 hits and a total of 111 included studies that represent 19 out of 48 SSA countries.From a HRM perspective, most studies researched HRM bundles that combined practices from motivation-enhancing, skills-enhancing, and empowerment-enhancing domains. Motivation-enhancing practices were most frequently researched, followed by skills-enhancing practices and empowerment-enhancing practices. Few studies focused on single HRM practices (instead of bundles). Training and education were the most researched single practices, followed by task shifting.From a performance perspective, our review reveals that employee outcomes and organizational outcomes are frequently researched, whereas team outcomes and patient outcomes are significantly less researched. Most studies report HRM interventions to have positively impacted performance in one way or another. As researchers have studied a wide variety of (bundled) interventions and outcomes, our analysis does not allow to present a structured set of effective one-to-one relationships between specific HRM interventions and performance measures. Instead, we find that specific outcome improvements can be accomplished by different HRM interventions and conversely that similar HRM interventions are reported to affect different outcome measures.In view of the high burden of disease, our review identified remarkable little evidence on the relationship between HRM and patient outcomes. Moreover, the presented evidence often fails to provide contextual characteristics which are likely to induce variety in the performance effects of HRM interventions. Coordinated research efforts to advance the evidence base are called for.
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Affiliation(s)
- Philipos Petros Gile
- Higher Education Institutions’ Partnership, PO BOX 14051, Addis Ababa, Ethiopia
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, PO Box 1738, 3000 DR Rotterdam, The Netherlands
| | - Martina Buljac-Samardzic
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, PO Box 1738, 3000 DR Rotterdam, The Netherlands
| | - Joris Van De Klundert
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, PO Box 1738, 3000 DR Rotterdam, The Netherlands
- Prince Mohammad Bin Salman College (MBSC) of Business & Entrepreneurship, 7082-BayLaSun-Juman St. Unit No. 1, King Abdullah Economic City, 23964-2522 Kingdom of Saudi Arabia
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Lawal BJ, Agbla SC, Bola-Lawal QN, Afolabi MO, Ihaji E. Patients' Satisfaction With Care From Nigerian Federal Capital Territory's Public Secondary Hospitals: A Cross-Sectional Study. J Patient Exp 2018; 5:250-257. [PMID: 30574544 PMCID: PMC6295802 DOI: 10.1177/2374373517752696] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Patients’ satisfaction remains an important tool for evaluating quality of care in the emerging global trend of patient-centered care. Aim: To assess satisfaction with care received by patients at public secondary hospitals in Abuja, north central Nigeria. Method: We measured patients’ satisfaction using structured questionnaire, and Cronbach α was used to assess consistency in item responses. A multivariate mixed-effects linear regression was fitted to identify factors influencing the overall satisfaction. Results: All satisfaction domains tested were scored at “intermediate-positive levels” except for the “feeling being valued and appreciated as patients” domain that scored the least positive response level. On the overall, respondents rated the hospitals at high satisfaction level. There was a significant positive association between patients’ satisfaction and careful listening of care providers; patients’ perception of being valued and appreciated by the hospital staff (P = .003 and P = .001, respectively). Conclusion: Our findings suggest high satisfaction of care at public hospitals in Abuja Nigeria. Patients satisfaction survey should be integrated into hospital management planning and administration as part of quality improvement.
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Affiliation(s)
- Bolarinde Joseph Lawal
- Medical Research Council Unit, Fajara, The Gambia.,FCT Hospitals Management Board, Abuja, Nigeria
| | - Schadrac C Agbla
- Medical Research Council Unit, Fajara, The Gambia.,London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | | | - Elvis Ihaji
- Department of Psychology, School of Postgraduate Studies, Benue State University, Makurdi, Nigeria
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Van der Merwe M, Cilliers M, Maré C, Van der Linde J, Le Roux M. Evaluation of a Zulu translation of the Parents' Evaluation of Developmental Status. Afr J Prim Health Care Fam Med 2017; 9:e1-e6. [PMID: 28697618 PMCID: PMC5506497 DOI: 10.4102/phcfm.v9i1.1365] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 02/20/2017] [Accepted: 03/02/2017] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND One of the greatest challenges in early communication intervention in South Africa is developing and implementing successful identification strategies in primary health care (PHC). A shortage of trained PHC personnel is one of the barriers to providing adequate health services in South Africa. This dearth of services creates the need to substitute clinician-administered developmental screening tools with parent-administered tools. AIM To determine the accuracy of the Zulu Parents' Evaluation of Developmental Status (PEDS) in comparison with the outcome of the English PEDS. SETTING The data were collected in a clinical, non-contrived environment at Stanza Bopape Community Health Clinic in Mamelodi, City of Tshwane. METHODS The PEDS is a standardised, parent-completed questionnaire regarding the child's general development. The English PEDS was translated into Zulu by a Zulu linguist. There were 99 potential participants in the study of whom 83 met the necessary prerequisites. RESULTS Of the participants whose home language is Zulu, 54% preferred the PEDS in English over the PEDS in Zulu. This indicates a skewed preference towards English, with only slight associations between language preference and age, education and home language. CONCLUSION The Zulu PEDS displayed high positive and negative correspondences, representative of an accurate translation of the English PEDS. It is recommended that this study should be repeated in a community where the majority are Zulu home language speakers.
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Soogun S, Naidoo M, Naidoo K. An evaluation of the use of the South African Triage Scale in an urban district hospital in Durban, South Africa. S Afr Fam Pract (2004) 2017. [DOI: 10.1080/20786190.2017.1307908] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
| | - M Naidoo
- Discipline of Family Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - K Naidoo
- Discipline of Family Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
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Indoor Temperatures in Patient Waiting Rooms in Eight Rural Primary Health Care Centers in Northern South Africa and the Related Potential Risks to Human Health and Wellbeing. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14010043. [PMID: 28067816 PMCID: PMC5295294 DOI: 10.3390/ijerph14010043] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 12/19/2016] [Accepted: 12/27/2016] [Indexed: 11/21/2022]
Abstract
Increased temperatures affect human health and vulnerable groups including infants, children, the elderly and people with pre-existing diseases. In the southern African region climate models predict increases in ambient temperature twice that of the global average temperature increase. Poor ventilation and lack of air conditioning in primary health care clinics, where duration of waiting time may be as long as several hours, pose a possible threat to patients seeking primary health care. Drawing on information measured by temperature loggers installed in eight clinics in Giyani, Limpopo Province of South Africa, we were able to determine indoor temperatures of waiting rooms in eight rural primary health care facilities. Mean monthly temperature measurements inside the clinics were warmer during the summer months of December, January and February, and cooler during the autumn months of March, April and May. The highest mean monthly temperature of 31.4 ± 2.7 °C was recorded in one clinic during February 2016. Maximum daily indoor clinic temperatures exceeded 38 °C in some clinics. Indoor temperatures were compared to ambient (outdoor) temperatures and the mean difference between the two showed clinic waiting room temperatures were higher by 2–4 °C on average. Apparent temperature (AT) incorporating relative humidity readings made in the clinics showed ‘realfeel’ temperatures were >4 °C higher than measured indoor temperature, suggesting a feeling of ‘stuffiness’ and discomfort may have been experienced in the waiting room areas. During typical clinic operational hours of 8h00 to 16h00, mean ATs fell into temperature ranges associated with heat–health impact warning categories of ‘caution’ and ‘extreme caution’.
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Ishijima H, Eliakimu E, Mshana JM. The “5S” approach to improve a working environment can reduce waiting time. TQM JOURNAL 2016. [DOI: 10.1108/tqm-11-2014-0099] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Purpose
– The purpose of this paper is to assess causal relations between the implementation of the 5S approach and the reduction of patients’ waiting time at out patient departments (OPDs) of hospitals in Tanzania.
Design/methodology/approach
– Patients’ waiting time was measured under the cluster randomized control trial (c-RCT). In all, 16 hospitals were chosen and divided into treatment and control groups using block randomization. Before the intervention, a baseline study was conducted at OPDs in all 16 hospitals. After one year of the intervention, the end-line study was carried out in both the groups. A comparison of the average waiting time reduction and Difference-in-Difference (DID) analysis was carried out to see the effect of the 5S approach on the reduction of patients’ waiting time.
Findings
– Statistical significance in reduction of patients’ waiting time was seen in the medical records sections (p=0.002) and consultation rooms (p=0.020) in the intervention group. The same trend was also seen using DID analysis (−15.66 min in medical record, −41.90 min in consultation rooms).
Research limitations/implications
– This study has the following limitations in terms of the data. The data were collected for only three days at the time of baseline survey, and again for three days at the time of the end-line survey from 16 hospitals. Moreover, piloted areas for the implementation of the 5S approach vary from hospital to hospital. There might be a bias in the measurement of a patient’s waiting time. Caveats are therefore needed in extrapolating the study results to other settings. Despite these caveats, the findings will provide important insights for implementing quality improvement programs in Tanzania and in other African countries for improvement of time factors.
Originality/value
– This study used c-RCT, and has proven the effectiveness of the 5S approach in improving the working environment and reducing patients’ waiting time at OPDs in several hospitals at district level in Tanzania.
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Aaronson EL, Marsh RH, Guha M, Schuur JD, Rouhani SA. Emergency department quality and safety indicators in resource-limited settings: an environmental survey. Int J Emerg Med 2015; 8:39. [PMID: 26520848 PMCID: PMC4628609 DOI: 10.1186/s12245-015-0088-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 10/16/2015] [Indexed: 11/16/2022] Open
Abstract
Background As global emergency care grows, practical and effective performance measures are needed to ensure high quality care. Our objective was to systematically catalog and classify metrics that have been used to measure the quality of emergency care in resource-limited settings. Methods We searched MEDLINE, Embase, CINAHL, and the gray literature using standardized terms. The references of included articles were also reviewed. Two researchers screened titles and abstracts for relevance; full text was then reviewed by three researchers. A structured data extraction tool was used to identify and classify metrics into one of six Institute of Medicine (IOM) quality domains (safe, timely, efficient, effective, equitable, patient-centered) and one of three of Donabedian’s structure/process/outcome categories. A fourth expert reviewer blinded to the initial classifications re-classified all indicators, with a weighted kappa of 0.89. Results A total of 1705 articles were screened, 95 received full text review, and 34 met inclusion criteria. One hundred eighty unique metrics were identified, predominantly process (57 %) and structure measures (27 %); 16 % of metrics were related to outcomes. Most metrics evaluated the effectiveness (52 %) and timeliness (28 %) of care, with few addressing the patient centeredness (11 %), safety (4 %), resource-efficiency (3 %), or equitability (1 %) of care. Conclusions The published quality metrics in emergency care in resource-limited settings primarily focus on the effectiveness and timeliness of care. As global emergency care is built and strengthened, outcome-based measures and those focused on the safety, efficiency, and equitability of care need to be developed and studied to improve quality of care and resource utilization. Electronic supplementary material The online version of this article (doi:10.1186/s12245-015-0088-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Emily L Aaronson
- Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA. .,Harvard Affiliated Emergency Medicine Residency, Brigham and Women's Hospital/Massachusetts General Hospital, Boston, MA, USA. .,Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA. .,Department of Emergency Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, USA.
| | - Regan H Marsh
- Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA. .,Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA.
| | - Moytrayee Guha
- Center for Clinical Excellence, Brigham and Women's Hospital, Boston, MA, USA.
| | - Jeremiah D Schuur
- Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA. .,Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA.
| | - Shada A Rouhani
- Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA. .,Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA.
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