Improved triage and emergency care for children reduces inpatient mortality in a resource-constrained setting.
OBJECTIVE
Early assessment, prioritization for treatment and management of sick children attending a health service are critical to achieving good outcomes. Many hospitals in developing countries see large numbers of patients and have few staff, so patients often have to wait before being assessed and treated.


METHODS
We present the example of a busy Under-Fives Clinic that provided outpatient services, immunizations and treatment for medical emergencies. The clinic was providing an inadequate service resulting in some inappropriate admissions and a high case-fatality rate. We assessed the deficiencies and sought resources to improve services.


METHODS
A busy paediatric outpatient clinic in a public tertiary care hospital in Blantyre, Malawi.


RESULTS
The main changes we made were to train staff in emergency care and triage, improve patient flow through the department and to develop close cooperation between inpatient and outpatient services. Training coincided with a restructuring of the physical layout of the department. The changes were put in place when the department reopened in January 2001.


CONCLUSIONS
Improvements in the process and delivery of care and the ability to prioritize clinical management are essential to good practice. Making the changes described above has streamlined the delivery of care and led to a reduction in inpatient mortality from 10-18% before the changes were made (before 2001) to 6-8% after.
Molyneux
Elizabeth
E
Paediatric Department, Queen Elizabeth Central Hospital, College of Medicine, Malawi. emolyneux@malawi.net
Ahmad
Shafique
S
Robertson
Ann
A
D000553:Ambulatory Care / Q000458:organization & administration*; D002662:Child Health Services / Q000458:organization & administration*; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000458:organization & administration* / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008295:Malawi; D009026:Mortality; D012621:Seasons; D014218:Triage / Q000379:methods*