127 research outputs found
Triage conducted by lay-staff and emergency training reduces paediatric mortality in the emergency department of a rural hospital in Northern Mozambique
Introduction
The majority of emergency paediatric death in African countries occur within the first 24 h of admission. A coloured triage system is widely implemented in high-income countries and the emergency triage and assessment treatment (ETAT) is recommended by the World Health Organization, but not put into practice in Mozambique. We implemented a three-colour triage system in a rural district hospital with lay-staff workers conducting the first triage.
Methods
A retrospective, before and after, mortality analysis was performed using routine patient files from the district hospital between 2014 and 2017. The triage system was implemented in August 2016. Inclusion criteria were children under 15 years of age that entered the emergency centre. Primary outcome was child mortality rate. Secondary outcomes included the percentage agreement between the clinical and non-clinical staff and the duration from triage to first treatment. We used a negative binomial model in STATA 15 to compare mortality rates, and Kappa statistics to estimate the agreement between clinical and non-clinical staff.
Results
4176 admissions were included. The mortality rate ratio (MMR) was 45% lower after the start of the intervention (2016; MRR = 0.55; 0.38, 0.81; p = 0.002), compared to before. To estimate the agreement between non-clinical and clinical staff, 548 (of the 671) patient files were included. The agreement was estimated at 88.7% (Kappa = 0.644; p < 0.001). The median waiting time decreased with urgency of the triage: 2 h33 for ‘green’/least serious (IQR 1 h58-3 h30), 21 min for yellow/serious (IQR 0 h10-0 h58) and nine minutes for ‘red’/urgent (IQR 2–40 min).
Conclusion
In a rural setting with nurse-led clinical care and non-clinician staff working at the triage reception, implementation of a three-coloured triage system was feasible. Triage and ETAT training was associated with a decrease of 45% of paediatric deaths. The impact on mortality, low cost, and ease of the implementation supports scaling this intervention in similar settings
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The radiological source terms pertinent to spent fuel shipping cask safety assessments are of three distinct origins. One of these concerns residual contamination within the cask due to handling operations and previous shipments. A second is associated with debris (''crud'') that had been deposited on the fuel rods in the course of reactor operation, and a third involves the radioactive material contained within the rods. Although the lattermost source of radiotoxic material overwhelms the others in terms of inventory, its release into the shipping cask, and thence into the biosphere, requires the breach of an additional release barrier, viz., the fuel rod cladding. Hence, except for the special case involving the transport of fuel rods containing previously breached claddings, considerations of the source terms due to material contained in the fuel rods are complicated by the need to address the likelihood of fuel cladding failure during transport. The purpose of this report is to describe a methodology for estimating the shipping cask source terms contribution due to radioactive material contained within the spent fuel rods. Thus, the probability of fuel cladding failure as well as radioactivity release is addressed. 8 refs., 2 tabs
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TMI-2 core examination
The examination of the damaged core at the Three Mile Island Unit 2 (TMI-2) reactor is structured to address the following safety issues: fission product release, transport, and deposition; core coolability; containment integrity; and recriticality during severe accidents; as well as zircaloy cladding ballooning and oxidation during so-called design basis accidents. The numbers of TMI-2 components or samples to be examined, the priority of each examination, the safety issue addressed by each examination, the principal examination techniques to be employed, and the data to be obtained and the principal uses of the data are discussed in this paper
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