Institute of Medicine, Kathmandu, Nepal.
Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
BMC Emerg Med. 2024 Nov 25;24(1):222. doi: 10.1186/s12873-024-01139-y.
In healthcare facilities, an efficient triage system is critical to optimize patient care. The main objective of this study was to explore the triage processes and practices in three different tiers of healthcare facilities in the Kathmandu Valley, Nepal.
A mixed-methods approach in this study comprised observations and interviews in ten healthcare settings across primary care centers (PHC; n = 6), secondary care centers (SHC; n = 3), and tertiary care hospital (n = 1). Data were collected from June to November 2023. Semi-structured interviews were conducted among patients (n = 30) including survey questionnaires among 144 healthcare workers (HCWs) focused on triage. The qualitative data were analyzed using Interpretative Phenomenological Analysis and quantitative data were analyzed to explore the median score on the consistent practice of triage based on the Likert scale.
PHCs had designated space for triage with less equipped emergency services and outpatient departments (OPDs) and received severely ill patients rarely. Although prioritizing critical patients and prompt care was part of the services, there was a lack of triage protocols with more than half of the HCWs (56.3%; 36/64) from the tertiary hospital reporting the availability of triage guidelines compared to SHCs (28.1%; 9/32) and PHCs (6.3%; 3/48). The majority of HCWs from the tertiary level recognized triage's effectiveness in reducing time lag, and prioritizing patients. Tertiary level had the consistent use of triage (94%; 60/64) compared to only around two-thirds in SHCs (66%; 19/29) and PHCs (62%; 28/45). Patients often attended PHC services for routine check-ups and were motivated by health insurance, affordability, free medicines, referral cards, and proximity. In the SHC, there was a well-equipped emergency department (ED) with specific guidelines, but its use was infrequent. Patients were unaware of the triage process and its utility. In all settings, while most HCWs had a basic knowledge of triage, some were not confident due to limited exposure to the triage process and training. Many HCWs reported the need for triage-related training and its' consistent implementation.
Consistent utilization of triage protocols, coupled with improved infrastructure, resource allocation, and training for healthcare workers is critical for the optimization of triage processes in healthcare settings in the Kathmandu Valley, Nepal.
在医疗保健机构中，高效的分诊系统对于优化患者护理至关重要。本研究的主要目的是探讨尼泊尔加德满都谷地三个不同层级医疗保健机构的分诊流程和实践。
本研究采用混合方法，包括在初级保健中心（PHC；n=6）、二级保健中心（SHC；n=3）和三级保健医院（n=1）的十个医疗保健场所进行观察和访谈。数据收集于 2023 年 6 月至 11 月。对 30 名患者进行半结构化访谈，并对 144 名医护人员（HCWs）进行问卷调查，重点关注分诊。对定性数据进行解释现象学分析，对定量数据进行分析，以探索基于李克特量表的分诊一致实践的中位数评分。
PHC 设有分诊专用空间，配备的紧急服务和门诊部（OPD）较少，很少接收重病患者。虽然优先考虑重症患者和及时护理是服务的一部分，但由于超过一半的 HCWs（56.3%；36/64）来自三级医院报告有分诊指南，而 SHC（28.1%；9/32）和 PHC（6.3%；3/48）的分诊协议不足。大多数来自三级水平的 HCWs 认识到分诊在减少时间延迟和优先患者方面的有效性。与只有三分之二左右的 SHC（66%；19/29）和 PHC（62%；28/45）相比，三级水平有一致的分诊使用（94%；60/64）。患者通常因医疗保险、负担能力、免费药物、转诊卡和距离而选择 PHC 服务。在 SHC，有一个设备齐全的急诊科（ED），有具体的指南，但使用频率不高。患者不知道分诊流程及其用途。在所有设置中，虽然大多数 HCWs 对分诊有基本的了解，但由于对分诊流程和培训的接触有限，一些人没有信心。许多 HCWs 报告需要进行与分诊相关的培训和一致实施。
在尼泊尔加德满都谷地的医疗保健机构中，优化分诊流程需要一致使用分诊协议，并改善基础设施、资源分配和医护人员培训。
