title: Task shifting an inpatient triage, assessment and treatment programme improves the quality of care for hospitalised Malawian children.
abstract: OBJECTIVE
  We aimed to improve paediatric inpatient surveillance at a busy referral hospital in Malawi with two new programmes: (i) the provision of vital sign equipment and implementation of an inpatient triage programme (ITAT) that includes a simplified paediatric severity-of-illness score, and (ii) task shifting ITAT to a new cadre of healthcare workers called 'vital sign assistants' (VSAs).
  
  
  METHODS
  This study, conducted on the paediatric inpatient ward of a large referral hospital in Malawi, was divided into three phases, each lasting 4 weeks. In Phase A, we collected baseline data. In Phase B, we provided three new automated vital sign poles and implemented ITAT with current hospital staff. In Phase C, VSAs were introduced and performed ITAT. Our primary outcome measures were the number of vital sign assessments performed and clinician notifications to reassess patients with high ITAT scores.
  
  
  RESULTS
  We enrolled 3994 patients who received 5155 vital sign assessments. Assessment frequency was equal between Phases A (0.67 assessments/patient) and B (0.61 assessments/patient), but increased 3.6-fold in Phase C (2.44 assessments/patient, P < 0.001). Clinician notifications increased from Phases A (84) and B (113) to Phase C (161, P = 0.002). Inpatient mortality fell from Phase A (9.3%) to Phases B (5.7) and C (6.9%).
  
  
  CONCLUSIONS
  ITAT with VSAs improved vital sign assessments and nearly doubled clinician notifications of patients needing further assessment due to high ITAT scores, while equipment alone made no difference. Task shifting ITAT to VSAs may improve outcomes in paediatric hospitals in the developing world.
authors.affiliation: Department of Pediatrics, University of Colorado, Denver, CO, USA. daniel.olson@childrenscolorado.org
authors.forename: Daniel
authors.initials: D
authors.lastname: Olson
authors.forename: Geoffrey A
authors.initials: GA
authors.lastname: Preidis
authors.forename: Robert
authors.initials: R
authors.lastname: Milazi
authors.forename: Jennifer K
authors.initials: JK
authors.lastname: Spinler
authors.forename: Norman
authors.initials: N
authors.lastname: Lufesi
authors.forename: Charles
authors.initials: C
authors.lastname: Mwansambo
authors.forename: Mina C
authors.initials: MC
authors.lastname: Hosseinipour
authors.forename: Eric D
authors.initials: ED
authors.lastname: McCollum
mesh_terms: D000488:Allied Health Personnel; D002673:Child, Hospitalized; D002675:Child, Preschool; D003142:Communication; D005260:Female; D006282:Health Personnel; D017052:Hospital Mortality; D006760:Hospitalization; D006761:Hospitals; D006801:Humans; D007223:Infant; D008295:Malawi / Q000453:epidemiology; D008297:Male; D058996:Quality Improvement; D012017:Referral and Consultation; D012720:Severity of Illness Index; D014218:Triage / Q000379:methods / Q000458:organization & administration / Q000592:standards; D055986:Vital Signs; D016526:Workload