title: Regional scale-up of an Emergency Triage Assessment and Treatment (ETAT) training programme from a referral hospital to primary care health centres in Guatemala.
abstract: OBJECTIVE
  Emergency Triage Assessment and Treatment (ETAT) was developed by the WHO to teach paediatric assessment, triage and initial management to healthcare workers (HCWs) in resource-limited hospital-based settings. This study sought to evaluate the extension of ETAT training from a regional hospital to paediatric HCWs at local primary care health centres (PHCs) in Guatemala.
  
  
  METHODS
  Prior to providing a 16 h ETAT training module, immediately after, and at 3, 6 and 12 months, we used written pre-tests and post-tests and five-point Likert surveys to evaluate, respectively, clinical knowledge and provider confidence in providing acute care paediatrics; hands-on clinical skills were tested at 3, 6 and 12 months.
  
  
  RESULTS
  Fifty-two HCWs (14 general physicians, 38 nurses) from four regional PHCs participated; 65%, 60% and 46% completed 3-month, 6-month and 12-month follow-ups, respectively. Test scores show significant acquisition of clinical knowledge initially, which was retained over time when tested at 3, 6 and 12 months (46 vs 70, p<0.001). Hands-on clinical skills scores demonstrated retention at 3, 6 and 12 months. Although participants were more confident about acute care paediatrics immediately after training (66 vs 104, p<0.001), this decreased with time, though not to pre-intervention levels.
  
  
  CONCLUSIONS
  ETAT trainings were successfully extended to PHCs in a resource-limited setting with significant knowledge acquisition and retention over time and improved HCW confidence with acute care paediatrics. This process could serve as a successful model for in-country and international scale-up of ETAT.
authors.affiliation: Department of Pediatrics, Section of Emergency Medicine, Baylor College of Medicine, Houston, Texas, USA Division of Emergency Medicine, Department of Pediatrics, Eastern Virginia Medical School, Norfolk, Virginia, USA.
authors.forename: Rupa
authors.initials: R
authors.lastname: Kapoor
authors.affiliation: Department of Pediatrics, Hospital Nacional Pedro Bethancourt, La Antigua, Guatemala.
authors.forename: Maria Antonieta
authors.initials: MA
authors.lastname: Sandoval
authors.affiliation: Department of Pediatrics, Hospital Nacional Pedro Bethancourt, La Antigua, Guatemala.
authors.forename: Leslie
authors.initials: L
authors.lastname: Avendaño
authors.affiliation: Department of Pediatrics, Section of Emergency Medicine, Baylor College of Medicine, Houston, Texas, USA.
authors.forename: Andrea T
authors.initials: AT
authors.lastname: Cruz
authors.affiliation: Department of Pediatrics, Hospital Nacional Pedro Bethancourt, La Antigua, Guatemala.
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Soto
authors.affiliation: Department of Pediatrics, Section of Emergency Medicine, Baylor College of Medicine, Houston, Texas, USA.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Camp
authors.affiliation: Department of Pediatrics, Section of Emergency Medicine, Baylor College of Medicine, Houston, Texas, USA.
authors.forename: Heather L
authors.initials: HL
authors.lastname: Crouse
mesh_terms: D002983:Clinical Competence; D003906:Developing Countries; D004521:Educational Measurement; D004635:Emergency Medicine / Q000193:education*; D005260:Female; D058005:General Practitioners / Q000193:education; D006166:Guatemala; D006801:Humans; D008297:Male; D009741:Nursing Staff, Hospital / Q000193:education; D010372:Pediatrics / Q000193:education*; D011320:Primary Health Care / Q000458:organization & administration*; D011446:Prospective Studies; D012017:Referral and Consultation; D012041:Regional Medical Programs / Q000458:organization & administration*; D014218:Triage
keywords: education, assessment; paediatrics, paediatric emergency medicine; triage