IMPLEMENTATION OF TRIAGE DURING THE COVID PANDEMIC AT SHALAMAR HOSPITAL LAHORE, PAKISTAN

Main Article Content

Hadia Eman Tariq
Fatima Waseem
Hafiz Umair Zulfiqar Ali
Dr Muhammad Umer
Dr Maham Farooq
Dr Amjad Farooq
Bilal Qammar

Keywords

Triage, COVID-19, Pandemic

Abstract

Objective:


To measure the extent of triage policies being implemented by the selected hospital staff for sorting the patients at the first point of reporting.


Methodology:


It is a descriptive cross-sectional study, it will be conducted online in the form of a questionnaire which will be circulated by using different networking sites i.e. Gmail and Whatsapp to healthcare workers of Shalamar Hospital working in the ER department. Data will be collected from Medical Officers, House Officers and from Post Graduate Residents of Shalamar Hospital Lahore. All other medical staff who are not directly related to the sorting of triage in COVID patients i.e. nurses, paramedics, senior consultants, general practitioners, doctors of other specialities are not included in the study. The questions will be focused on the implementation and problems faced during implementation of triage during the pandemic. The data will be kept in password protected computers of investigators only. The official statistician of SMDC will be requested to analyze the data. The data will be entered and analyzed on SPSS v.19.


Statistical analysis:


 We haveused IBM spss 21 for data analysis. Descriptive statistics were carried out on data with  mean +/- SD and frequency trends noted. Frequency trends were noted for various variables relating to triage implementation e.g. triage implementation and reduction of burden on scarce sources. Percentage was calculated for responses by HCWs to our questionnaire. Associations were measured by chi square test which yielded P value.


 Results:


Mean age of healthcare workers was 22.41. Demographically 49% males and 51% females. 18% MOs and 31% PGRs were involved. Doctors who agreed to the question that triage was helpful were 96%, increased surge capacity has helped implementation of triage were 71%, telephonic triage was helpful in reducing nosocomial spread of disease were 81%, doctors agreed on treating patients on survival probability if resources are running out were 77% and 63% doctors agreed on this that Shalamar Hospital is following WHO provided criteria of triage. 


Conclusion:                                                           


This study has evaluated the protocols and implementation of triage during COVID-19 pandemic in Shalamar Medical Hospital. It has also assessed telephonic based screening and triage services in the health care system with regard to COVID-19 pandemic.


Effective and intensive screening by the history of contact risk, symptoms and careful use of hospital resources based on patient’s survival probability are significant strategies in preventing transmission of disease and saving lives of patients. Telephone based medical services have the potential to greatly improve triage efficiency and prevent unnecessary visits to the hospital.

Abstract 134 | PDF Downloads 46

References

1. https://www.oxfordlearnersdictionaries.com/definition/american_english/triage
2. Christian MD. Triage. Critical care clinics. 2019 Oct 1;35(4):575-89.
3. Hashmi M, Taqi A, Memon MI, Ali SM, Khaskheli S, Sheharyar M, Hayat M, Shiekh M, Kodippily C, Gamage D, Dondorp AM. A national survey of critical care services in hospitals accredited for training in a lower-middle income country: Pakistan. Journal of critical care. 2020 Dec 1;60:273-8.
4. https://fbn.miami.edu/_assets/pdf/resources/covid-19-resources/covid19-guidelines-pakistan.pdf
5. Emanuel EJ, Persad G, Upshur R. Allocation of scarce medical resources in the time of Covid-19 [published online ahead of print 2020]. N Engl J Med.;10.
6. Riccioni L, Bertolini G, Giannini A, Vergano M, Gristina G, Livigni S, Mistraletti G, di Lavoro Siaarti FP, Rianimazione SI, Intensiva ET. Clinical ethics recommendations for the allocation of intensive care treatments, in exceptional, resource-limited circumstances. Recenti progressi in medicina. 2020 Apr;111(4):207-11.
7. Antommaria AH, Gibb TS, McGuire AL, Wolpe PR, Wynia MK, Applewhite MK, Caplan A, Diekema DS, Hester DM, Lehmann LS, McLeod-Sordjan R. Ventilator triage policies during the COVID-19 pandemic at US hospitals associated with members of the association of bioethics program directors. Annals of Internal Medicine. 2020 Aug 4;173(3):188-94.
8. Joebges S, Biller-Andorno N. Ethics guidelines on COVID-19 triage--an emerging international consensus. Critical Care. 2020 May 6;24(1):NA-.
9. Cervino G, Oteri G. COVID-19 Pandemic and Telephone Triage before Attending Medical Office: Problem or Opportunity?. Medicina. 2020;56:250.
10. Wallace DW, Burleson SL, Heimann MA, Crosby JC, Swanson J, Gibson CB, Greene C. An adapted emergency department triage algorithm for the COVID‐19 pandemic. Journal of the American College of Emergency Physicians Open. 2020 Dec;1(6):1374-9.
11. Khursheed M, Fayyaz J, Jamil A. Setting up triage services in the emergency department: experience from a tertiary care institute of Pakistan. A journey toward excellence. Journal of Ayub Medical College. 2015;27(3):737.
12. Moon SH, Shim JL, Park KS, Park CS. Triage accuracy and causes of mistriage using the Korean Triage and Acuity Scale. PLoS One. 2019 Sep 6;14(9):e0216972.
13. Kongkamol C, Padungkul L, Rattanajarn N, Srisara S, Rangsinobpakhun L, Apiwan K, Sompan J, Prathipsawangwong C, Buathong P, Chann S, Sathirapanya P. Implementation of Triage System and Shortening Patient Journey Time to Prevent COVID-19 Transmission in a University Hospital during a Pandemic. International Journal of Environmental Research and Public Health. 2021 Jan;18(13):6996.
14. Wake RM, Morgan M, Choi J, Winn S. Reducing nosocomial transmission of COVID-19: implementation of a COVID-19 triage system. Clinical Medicine. 2020 Sep;20(5):e141.
15. Judson TJ, Odisho AY, Neinstein AB, Chao J, Williams A, Miller C, Moriarty T, Gleason N, Intinarelli G, Gonzales R. Rapid design and implementation of an integrated patient self-triage and self-scheduling tool for COVID-19. Journal of the American Medical Informatics Association. 2020 Jun;27(6):860-6.
16. NeJhaddadgar N, Ziapour A, Zakkipour G, Abbas J, Abolfathi M, Shabani M. Effectiveness of telephone-based screening and triage during COVID-19 outbreak in the promoted primary healthcare system: a case study in Ardabil province, Iran. Journal of Public Health. 2020 Nov 13:1-6.
17. Wang Q, Wang X, Lin H. The role of triage in the prevention and control of COVID-19. Infection Control & Hospital Epidemiology. 2020 Jul;41(7):772-6.

Most read articles by the same author(s)