title: Quality and Effectiveness of a Pediatric Triage Training Program in a Guatemalan Public Hospital.
abstract: OBJECTIVE
  This study aimed to develop and implement an Emergency Triage Assessment and Treatment (ETAT) training program at a Guatemalan public hospital. Collaborators included Baylor College of Medicine/Texas Children's Hospital, the Guatemalan Ministry of Health, and the Pan American Health Organization.
  
  
  METHODS
  The ETAT is a World Health Organization program to teach pediatric assessment, triage, and initial management to health care workers in resource-limited settings. The Baylor College of Medicine/Texas Children's Hospital created ETAT training materials in Spanish (Clasificación, Evaluación y Tratamiento de Emergencias Pediátricas [CETEP]) and conducted a train-the-trainer course for Hospital Nacional Pedro Bethancourt (HNPB) health care leadership. The HNPB subsequently conducted local trainings using a modified curriculum. Midcourse modifications based on evaluations and focus groups included distribution of manuals before training and an adding a day to the course.Course quality was assessed using participant evaluations and comparing pretest and posttest scores. Effectiveness was defined as 90% concordance between triage levels assigned by participants and facilitators.
  
  
  RESULTS
  A total of 249 health care workers were trained by 24 HNPB facilitators. Mean pretest and posttest scores were 55 and 70, respectively (P < 0.001). On a 4-point scale, participants rated overall course quality and effectiveness as 3.6. Mean pretest (49 vs 58, P = 0.002) and posttest scores (68 vs 72, P = 0.01) improved for groups trained after modifications, as did evaluations for course quality (3.4 vs 3.7, P < 0.001) and effectiveness (3.4 vs 3.8, P < 0.001). Triage levels were assigned with 95% concordance (confidence interval, 91.9-97.3) between participants and facilitators.
  
  
  CONCLUSIONS
  Hospital Nacional Pedro Bethancourt experts conducted high-quality trainings with locally relevant CETEP (ETAT) material. Trainings were effective and well received. The pediatric emergency department at HNPB now uses a triage system based on CETEP (ETAT).
authors.affiliation: From the *Section of Emergency Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, TX; †Department of Pediatrics, Hospital Nacional Pedro Bethancourt, La Antigua, Guatemala; ‡Global Health Initiative, Texas Children's Hospital, Houston, TX; and § Division of Pediatric Emergency Medicine, Department of Emergency Medicine, New York University School of Medicine, New York, NY.
authors.forename: Heather L
authors.initials: HL
authors.lastname: Crouse
authors.forename: Henry
authors.initials: H
authors.lastname: Vaides
authors.forename: Francisco
authors.initials: F
authors.lastname: Torres
authors.forename: Elise M
authors.initials: EM
authors.lastname: Ishigami
authors.forename: Michael T
authors.initials: MT
authors.lastname: Walsh
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Soto
authors.forename: Susan B
authors.initials: SB
authors.lastname: Torrey
mesh_terms: D004636:Emergency Service, Hospital / Q000592:standards*; D005260:Female; D006166:Guatemala; D006282:Health Personnel / Q000193:education*; D006776:Hospitals, Pediatric / Q000592:standards*; D006801:Humans; D008297:Male; D058996:Quality Improvement; D014218:Triage / Q000592:standards*; D000078329:Workforce