Weiner Yael, Therriault Claire, Duwal Tina, Basnet Samjhana, Shrestha Roshana, Shrestha Sanu Krishna
Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.
Department of General Practice and Emergency Medicine, Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal.
Int J Emerg Med. 2025 Jul 28;18(1):136. doi: 10.1186/s12245-025-00961-w.
Effective triage is critical for prioritizing emergency care. However, many low- and middle-income countries lack standardized triage systems. Nepal has been working to introduce the WHO's Interagency Integrated Triage Tool (IITT) into emergency departments nationwide. Still, successful implementation requires context-specific adaptations to address operational realities and resource constraints.
This study aimed to collaboratively adapt the IITT for use in the Dhulikhel Hospital Emergency Department by incorporating frontline staff insights to develop a feasible, sustainable triage workflow.
Five focus groups composed of doctors, nurses, and paramedics were conducted. Through semi-structured discussions, we explored staff perceptions of areas for improvement in the existing triage processes. Participants then generated site-specific workflow models through iterative brainstorming sessions, progressively refining the design into a final consensus-based model.
Participants, representing over 80% of clinical staff, identified key barriers to effective triage, including inconsistent communication, unclear handoff responsibilities, and insufficient training. The final triage workflow addressed many critical challenges raised in discussion sessions, provided a standardized and customized triage process, and resulted in high reported confidence in its utility.
This study demonstrates the value of a bottom-up, staff-centered approach to triage system development and implementation. Our focus group design offers a practical, replicable framework for low-resource emergency departments seeking to implement the IITT or similar protocols into their ED operations. Future efforts should focus on validating the workflow's impact on patient outcomes and triage efficiency and investing in thorough and longitudinal training to support sustained adoption.
有效的分诊对于确定紧急护理的优先级至关重要。然而，许多低收入和中等收入国家缺乏标准化的分诊系统。尼泊尔一直在努力将世界卫生组织的机构间综合分诊工具（IITT）引入全国的急诊科。尽管如此，要成功实施，仍需要根据具体情况进行调整，以应对实际操作中的现实情况和资源限制。
本研究旨在通过纳入一线工作人员的见解，共同调整IITT，使其适用于杜利凯尔医院急诊科，以制定可行、可持续的分诊工作流程。
组织了由医生、护士和护理人员组成的五个焦点小组。通过半结构化讨论，我们探讨了工作人员对现有分诊流程中有待改进领域的看法。参与者随后通过反复的头脑风暴会议生成了针对具体地点的工作流程模型，并逐步将设计完善为最终基于共识的模型。
代表超过80%临床工作人员的参与者确定了有效分诊的关键障碍，包括沟通不一致、交接责任不明确和培训不足。最终的分诊工作流程解决了讨论中提出的许多关键挑战，提供了标准化且定制化的分诊流程，并使工作人员对其效用的信心较高。
本研究证明了自下而上、以工作人员为中心的分诊系统开发和实施方法的价值。我们的焦点小组设计为资源匮乏的急诊科提供了一个实用、可复制的框架，这些急诊科希望将IITT或类似方案纳入其急诊科运营。未来的工作应侧重于验证该工作流程对患者结局和分诊效率的影响，并投入全面和长期的培训以支持持续采用。
