Impact of an Emergency Triage Assessment and Treatment (ETAT)-based triage process in the paediatric emergency department of a Guatemalan public hospital.
Triage process implementation has been shown to be effective at improving patient outcomes. This study sought to develop, implement and assess the impact of an Emergency Triage Assessment and Treatment (ETAT)-based emergency triage process in the paediatric emergency department (PED) of a public hospital in Guatemala.



The study was a quality improvement comparison with a before/after design. Uptake was measured by percentage of patients with an assigned triage category. Outcomes were hospital admission rate, inpatient length of stay (LOS), and mortality as determined by two distinct medical record reviews for 1 year pre- and post-intervention: a random sample (RS) of all PED patients and records for all critically-ill (CI) children [serious diagnoses or admission to the paediatric intensive care unit (PICU)]. Demographics, diagnoses and disposition were recorded.



The RS totalled 1027 (51.4% male); median ages pre- and post-intervention were 2.0 and 2.4 years, respectively. There were 196 patients in the CI sample, of whom 56.6% were male and one-third were neonates; median ages of the CI group pre- and post-intervention were 3.1 and 5.6 months, respectively. One year after implementation, 97.5% of medical records had been assigned triage categories. Triage categories (RS/CI) were: emergency (2.9%/54.6%), priority (47.6%/44.4%) and non-urgent (49.4%/1.0%). The CI group was more frequently diagnosed with shock (25%/1%), seizures (9%/0.5%) and malnutrition (6%/0.5%). Admission rates for the RS (8% vs 4%, P=0.01) declined after implementation. For the CI sample, admission rate to the PICU (47% vs 24%, P=0.002) decreased and LOS (7.3 vs 5.7 days, P=0.09) and mortality rates (12% vs 6%, P=0.15) showed trends toward decreasing post-implementation.



Paediatric-specific triage algorithms can be implemented and sustained in resource-limited settings. Significant decreases in admission rates (both overall and for the PICU) and trends towards decreased LOS and mortality rates of critically ill children suggest that ETAT-based triage systems have the potential to greatly improve patient care in Latin America.
a Department of Pediatrics, Section of Emergency Medicine , Baylor College of Medicine , Houston , Texas , USA.
Heather L
HL
Crouse
b Department of Pediatrics , Hospital Nacional Pedro Bethancourt , La Antigua , Guatemala.
Francisco
F
Torres
b Department of Pediatrics , Hospital Nacional Pedro Bethancourt , La Antigua , Guatemala.
Henry
H
Vaides
c Global Health Initiative , Texas Children's Hospital , Houston , Texas , USA.
Michael T
MT
Walsh
c Global Health Initiative , Texas Children's Hospital , Houston , Texas , USA.
Elise M
EM
Ishigami
a Department of Pediatrics, Section of Emergency Medicine , Baylor College of Medicine , Houston , Texas , USA.
Andrea T
AT
Cruz
a Department of Pediatrics, Section of Emergency Medicine , Baylor College of Medicine , Houston , Texas , USA.|d Department of Emergency Medicine , Division of Pediatric Emergency Medicine, New York University School of Medicine , New York City , USA.
Susan B
SB
Torrey
b Department of Pediatrics , Hospital Nacional Pedro Bethancourt , La Antigua , Guatemala.
Miguel A
MA
Soto
D002648:Child; D046688:Child Mortality; D002675:Child, Preschool; D016638:Critical Illness / Q000628:therapy*; D004636:Emergency Service, Hospital / Q000592:standards / Q000706:statistics & numerical data*; D005260:Female; D006166:Guatemala; D006760:Hospitalization / Q000706:statistics & numerical data*; D006779:Hospitals, Public; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D010372:Pediatrics; D011446:Prospective Studies; D058996:Quality Improvement; D012189:Retrospective Studies; D014218:Triage / Q000379:methods* / Q000706:statistics & numerical data
BCM/TCH, Baylor College of Medicine/Texas Children’s Hospital; CETEP, Clasificación Evaluación y Tratamiento de Emergencias Pediátricas; CI, critically ill sample; Clasificación; ETAT; Emergency Triage Assessment and Treatment; Emergency Triage Assessment and Treatment (ETAT); Evaluación y Tratamiento de Emergencias Pediátricas (CETEP); HCW, shealthcare workers; HNPB, Hospital Nacional Pedro Bethancourt; International emergency medicine; LOS, inpatient length of stay; MoH, Guatemalan Ministry of Health; PAHO, Pan-American Health Organization; PED, paediatric emergency department; PICU, paediatric intensive care unit; Paediatric emergency medicine; Paediatric triage; QI, quality improvement; RS, random sample