P2B208: Implementation of a Triage System at the Pediatric Emergency Center of the Cocody University Hospital in Abidjan, côte d’ivoire

Purpose/Objectives: Triage has been shown to reduce delays in treatment, admission and transfer rates and in-hospital child mortality. However, it is often not performed in many resource-constrained settings. This quality improvement initiative aims to develop and implement a triage system for acutely ill children with the goal of reducing pediatric hospitalization rates and inpatient mortality and morbidity at the Cocody University Hospital by promoting early recognition and stabilization of emergently ill children.

Design/Methods: The Abidjan Triage Scale (ATS) was adapted from the South African Triage Scale (SATS) by a group of pediatric faculty and residents at the CHU Cocody in May 2022. The ATS has four acuity levels based on presenting signs/chief complaints and a triage early warning score (TEWS) calculated using the patient’s vital signs (figures 1and 2). An ATS triage protocol and triage training materials were developed by our author group. In March 2023, 7 medical students completing their pediatric clerkship were trained to perform triage using the ATS. The training session consisted of a 60-minute didactic lecture followed by the completion of 11 clinical vignettes. Students on call were responsible for triaging all patients arriving at the PEC. Descriptive statistics were calculated for patients triaged and ATS acuity levels assigned. Fisher’s exact test was performed to determine statistically significant differences in disposition between high acuity and low acuity levels. A p-value of < 0.05 was considered statistically significant.

Results: Triage was performed on 70% (55/79) of patient arrivals between March 1st and March 23rd 2023. 38% presented with a life-threatening emergency (21/55), 27% (15/55) had very urgent signs, 20% (11/55) had urgent signs, 13% (7/55) had a non-urgent acuity level and 1 patient (2%) was deceased upon arrival. 98% of patients (54/55) were assigned the correct triage level based on their chief complaints, presenting signs and TEWS. When TEWS were required to assign acuity levels, 85% were calculated correctly. Only one case of underestimation (2%) occurred due to an incorrectly calculated TEWS. Patients with higher acuity levels (red or orange) were more likely to be admitted than those with lower acuity levels (yellow or green) (94% vs 67%, p=0.0217).

Conclusion/Discussion: These preliminary results suggest that the ATS is an accurate and reliable triage system adapted to the PEC at CHU Cocody. An emphasis should be placed on accurate and complete vital sign record keeping and TEWS calculation during training to optimize triage accuracy. Higher ATS acuity levels are associated with likelihood of hospitalization. Given unusually low patient volumes during our study period, we could not investigate the effect of triage on stabilizing treatment delays. More data is needed to determine whether triage implementation has a long-term effect on hospitalization rates, in hospital mortality and morbidity.