Implementation of a novel three-tier triage tool in Papua New Guinea: A model for resource-limited emergency departments

World Health Assembly. Resolution 72.16. Emergency care systems for universal health coverage: ensuring timely care for the acutely ill and injured. https://apps.who.int/gb/ebwha/pdf_files/WHA72/A72_R16-en.pdf. Published 2019. Accessed January 20, 2020. Mitchell, 2019, World Health Assembly resolution 72.16: what are the implications for the Australasian College for Emergency Medicine and emergency care development in the Indo‐Pacific?, Emerg Med Australas, 31, 696, 10.1111/1742-6723.13373 FitzGerald, 2010, Emergency department triage revisited, Emerg Med J, 27, 86, 10.1136/emj.2009.077081 Farrokhnia, 2011, Emergency department triage scales and their components: a systematic review of the scientific evidence, Scand J Trauma Resusc Emerg Med, 19, 42, 10.1186/1757-7241-19-42 Hinson, 2019, Triage performance in emergency medicine: a systematic review, Ann Emerg Med, 74, 140, 10.1016/j.annemergmed.2018.09.022 Jenson, 2018, Reliability and validity of emergency department triage tools in low- and middle-income countries, Eur J Emerg Med, 25, 154, 10.1097/MEJ.0000000000000445 Hansoti, 2017, Reliability and validity of pediatric triage tools evaluated in low resource settings: a systematic review, BMC Pediatr, 17, 37, 10.1186/s12887-017-0796-x Wanefalea, 2019, Effective triage in the Pacific region: the development and implementation of the Solomon Islands Triage scale, Emerg Med Australas, 31, 451, 10.1111/1742-6723.13248 Wallis, 2006, The Cape Triage score - a triage system for South Africa, South African Med J, 96, 53 Molyneux, 2006, Improved triage and emergency care for children reduces inpatient mortality in a resource-constrained setting, Bull World Health Organ, 84, 314, 10.2471/BLT.04.019505 Duke, 2016, New WHO guidelines on emergency triage assessment and treatment, Lancet, 387, 721, 10.1016/S0140-6736(16)00148-3 World Health Organization. Emergency Triage assessment and treatment (ETAT) course. https://www.who.int/maternal_child_adolescent/documents/9241546875/en/. Accessed September 13, 2020. 2011 Meyer, 2018, Validity of the South African Triage Scale in a rural district hospital, Afr J Emerg Med, 8, 145, 10.1016/j.afjem.2018.07.004 Wangara, 2019, Implementation and performance of the South African Triage scale at Kenyatta National Hospital in Nairobi, Kenya, Int J Emerg Med, 12, 10.1186/s12245-019-0221-3 Uwamahoro, 2020, Evaluation of a modified South African Triage score as a predictor of patient disposition at a tertiary hospital in Rwanda, African J Emerg Med, 10, 17, 10.1016/j.afjem.2019.10.001 Dalwai, 2017, Is the South African Triage scale valid for use in Afghanistan, Haiti and Sierra Leone?, BMJ Glob Heal, 2 Sunyoto, 2014, Providing emergency care and assessing a patient triage system in a referral hospital in Somaliland: a cross-sectional study, BMC Health Serv Res, 14, 10.1186/s12913-014-0531-3 Bruijns, 2008, Effect of introduction of nurse triage on waiting times in a South African emergency department, Emerg Med J, 25, 395, 10.1136/emj.2007.049411 Bruijns, 2008, A prospective evaluation of the Cape triage score in the emergency department of an urban public hospital in South Africa, Emerg Med J, 25, 398, 10.1136/emj.2007.051177 Lowsby, 2017, An assessment of nurse-led triage at Connaught Hospital, Sierra Leone in the immediate post-Ebola period, African J Emerg Med, 7, 51, 10.1016/j.afjem.2016.10.003 Massaut, 2017, The modified south African triage scale system for mortality prediction in resource-constrained emergency surgical centers: a retrospective cohort study, BMC Health Serv Res, 17, 594, 10.1186/s12913-017-2541-4 Dalwai, 2014, Reliability and accuracy of the South African Triage Scale when used by nurses in the emergency department of Timergara Hospital, Pakistan, South African Med J, 104, 372, 10.7196/SAMJ.7604 Rominski, 2014, The implementation of the South African Triage Score (SATS) in an urban teaching hospital, Ghana, Afr J Emerg Med, 4, 71, 10.1016/j.afjem.2013.11.001 Phillips, 2020, Emergency care status, priorities and standards for the Pacific region: a multiphase survey and consensus process across 17 different Pacific Island Countries and Territories, Lancet Reg Heal - West Pacific, 1 World Health Organization. Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected. https://www.who.int/publications-detail/clinical-management-of-severe-acute-respiratory-infection-when-novel-coronavirus-(ncov)-infection-is-suspected. Accessed July 3, 2020. World Health Organization. Clinical care of severe acute respiratory infections - tool kit. https://www.who.int/publications/i/item/clinical-care-of-severe-acute-respiratory-infections-tool-kit. Accessed October 1, 2020. Woodruff, 2020, COVID‐19 and the Indo-Pacific: implications for resource‐limited emergency departments, Med J Aust, 213, 345, 10.5694/mja2.50750 Ayebare, 2020, Adoption of COVID-19 triage strategies for low-income settings, Lancet Respir Med, 8, e22, 10.1016/S2213-2600(20)30114-4 Baker, 2020, Essential care of critical illness must not be forgotten in the COVID-19 pandemic, Lancet, 6736, 19 2012, Papua New Guinea Department of Health. Howes, 2012 Mullan, 2007, Non-physician clinicians in 47 sub-Saharan African countries, Lancet, 370, 2158, 10.1016/S0140-6736(07)60785-5 Mitchell, 2019, The road to paradise: developing emergency medicine in the highlands of Papua New Guinea, Your ED, 28 Curry, 2004, The first year of a formal emergency medicine training programme in Papua New Guinea, Emerg Med Australas, 16, 343 Phillips, 2012, Capacity building in emergency care: an example from Madang, Papua New Guinea, Emerg Med Australas, 24, 547, 10.1111/j.1742-6723.2012.01597.x Phillips, 2020, A Pacific needs analysis model: a proposed methodology for assessing the needs of facility-based emergency care in the Pacific region, BMC Health Serv Res, 20, 560, 10.1186/s12913-020-05398-w Emergency Medicine Society of South Africa. The South African Triage scale (SATS). https://emssa.org.za/special-interest-groups/the-south-african-triage-scale-sats/. Accessed September 12, 2020. Western Highlands Provincial Health Authority. New emergency care system for Mt Hagen hospital. https://www.whhs.gov.pg/2019/05/new-emergency-care-system-for-mt-hagen-hospital/. Accessed September 1, 2019. EMTV. New emergency care system trialed at Mt Hagen hospital. https://emtv.com.pg/new-emergency-care-system-trialed-at-mt-hagen-general-hospital/. Accessed November 1, 2019. Peki R. Mt Hagen hospital pioneers new system. Post-Courier. November 6, 2019. Rhodes D., Antoine E.Practitioners’ handbook for capacity development: a cross-cultural approach. Melbourne: Leadership Strategies. 2013. Mowafi, 2019, Emergency care surveillance and emergency care registries in low-income and middle-income countries: conceptual challenges and future directions for research, BMJ Glob Heal, 4, 1 Cibulskis, 2002, Information systems for health sector monitoring in Papua New Guinea, Bull World Health Organ, 80, 752 Yamamoto, 2012, Migration of health workers in the Pacific islands, Asia Pacific J Public Heal, 24, 697, 10.1177/1010539512453259 Worster, 2004, Assessment of inter-observer reliability of two five-level triage and acuity scales: a randomized controlled trial, CJEM, 6, 240, 10.1017/S1481803500009192 Australian Government Department of Health. Emergency Triage Education Kit. https://www1.health.gov.au/internet/main/publishing.nsf/Content/casemix-ED-Triage Review Fact Sheet Documents. Accessed April 1, 2019. Mitchell, 2019, Triage in Papua New Guinea: a collaborative development project. Clark, 2012, Reductions in inpatient mortality following interventions to improve emergency hospital care in Freetown, Sierra Leone. Morgan D, editor, PLoS ONE, 7, e41458, 10.1371/journal.pone.0041458 Dekker-Boersema, 2019, Triage conducted by lay-staff and emergency training reduces paediatric mortality in the emergency department of a rural hospital in Northern Mozambique, Afr J Emerg Med, 9, 172, 10.1016/j.afjem.2019.05.005