Global Team, Royal College of Paediatrics and Child Health , London, UK.
Developmental Neurosciences Programme, UCL GOS Institute of Child Health , London, UK.
Paediatr Int Child Health. 2020 Aug;40(3):186-193. doi: 10.1080/20469047.2020.1713610. Epub 2020 Jan 22.
In the wake of the Ebola virus disease (EVD) epidemic in Sierra Leone, secondary care facilities faced an increase in admissions with few members of medical staff available to assess and treat patients. This led to long waiting times in hospital outpatient departments. The study was undertaken in the outpatient department of Ola During Children's Hospital (the tertiary paediatric hospital for Sierra Leone) in the period immediately following the EVD epidemic of 2014-2015.
This retrospective analysis of operational programme data aimed to assess whether a quality-improvement approach and task-sharing between medical and nursing staff improved the quality of triage and the timeliness of care.
All staff working in the outpatient department were offered a 4-week training course, followed by on-the-job supervision and support for 6 months. Nurses who successfully completed the course were given responsibility for the initial assessment of sick patients and for prescribing and giving initial treatment. Data were collected at three points: before intervention and at 3 and 6 months after initiation of the intervention. All children presenting to the hospital for medical attention between 0800 and 1400 Monday to Friday were included. Triage assessment by the outpatient nurse was compared to that made by a clinically experienced observer, and the time taken for each child to be triaged, assessed and given initial treatment was recorded.
Between months 0 and 6 of the intervention, detection of emergency signs by the triage nurse improved from 30% to 100%, and detection of priority signs improved from 34% to 100%. For children presenting with emergency signs, the median time between triage and full assessment improved from 57 minutes before intervention to 17 minutes at 3 months and 5 minutes at 6 months (< 0.0005). For the same group, median time between triage and first antibiotic or antimalarial treatment improved from 220 minutes before intervention to 40 minutes at 3 months and 18 minutes at 6 months (= 0.006).
The results indicate that, with appropriate training and support, extending the emergency assessment and treatment of sick children to nursing staff in West African hospitals may improve the accuracy of triage and the time to assessment and treatment of children presenting with signs of serious illness.
在塞拉利昂埃博拉病毒病（EVD）疫情之后，二级保健机构的住院人数增加，而评估和治疗患者的医务人员却寥寥无几。这导致医院门诊部门的候诊时间延长。本研究是在 2014-2015 年 EVD 疫情后立即在 Ola During 儿童医院（塞拉利昂的三级儿科医院）的门诊部门进行的。
本项回顾性操作方案数据分析旨在评估质量改进方法和医护人员之间的任务分担是否提高了分诊质量和医疗及时性。
为门诊部门的所有工作人员提供为期 4 周的培训课程，随后在 6 个月内进行在职监督和支持。成功完成课程的护士负责对患病儿童进行初步评估以及开处方和进行初步治疗。数据在三个时间点收集：干预前和干预开始后 3 个月和 6 个月。所有在周一至周五 0800 至 1400 期间到医院就诊的儿童均被纳入研究。门诊护士的分诊评估与具有临床经验的观察者进行比较，并记录每个儿童分诊、评估和接受初步治疗所需的时间。
在干预的第 0 至 6 个月期间，分诊护士对急症征象的检出率从 30%提高到 100%，对优先征象的检出率从 34%提高到 100%。对于出现急症征象的儿童，从分诊到全面评估的中位数时间从干预前的 57 分钟缩短至 3 个月时的 17 分钟和 6 个月时的 5 分钟（<0.0005）。对于同一组儿童，从分诊到首次使用抗生素或抗疟药物治疗的中位数时间从干预前的 220 分钟缩短至 3 个月时的 40 分钟和 6 个月时的 18 分钟（=0.006）。
结果表明，通过适当的培训和支持，将对西非医院患病儿童的紧急评估和治疗扩展到护理人员，可能会提高分诊的准确性和对出现严重疾病征象的儿童进行评估和治疗的时间。
