|Case one: “Pediatric Preparedness of Lebanese Emergency Departments” ||Case two: “Improving triage in a Botswana Emergency Department”. [10, 11]|
A nationwide survey of all Lebanese hospitals with Emergency Departments (ED) that care for children highlighted that care was provided by a variety of physicians, most without any specific pediatric, pediatric critical care, or pediatric emergency care training.
Study checklist key points:
• Objective: The goal of the principal investigator, RS, was to understand the precarious state of pediatric emergency medicine (PEM) in Lebanon in order to further its development. Specifically, she aimed to describe the EDs of hospitals that cared for children.
• Methodology: A written survey of all Lebanese hospitals with EDs that care for children.
• Culture and partnership: A partnership with an emergency medicine national leader was initially established via relationships that RS already had in place. Discussions between RS and the local partner lead to the specific aim. The participants’ roles in the project were delineated beforehand and authorship credits assigned. The key roles of the local partner included identifying a local research assistant, the wording of the survey in order to facilitate understanding by Lebanese physicians, and helping approach the different hospitals in Lebanon. Culturally, Lebanese respond better to personal contact; therefore, speaking the local languages and establishing and maintaining relationships were key in identifying a local partner as well as recruiting hospitals.
• Institutional Review Board and Ethics: RS obtained Institutional Review Board (IRB) approval from the US home institution and from the local partners’ institution.
• Logistics: Time and funding were all from personal resources.
A key result of the study, that unspecialized physicians care for acutely ill and injured children, identified areas for potential intervention. In response to these results, RS partnered with local physicians to create a PEM track in the following Lebanese Emergency Medicine Conference and is now developing a PEM curriculum for the first four-year Emergency Medicine residency program in Lebanon.
A quality improvement project team adapted a regionally tested triage system, the South African Triage Scale (SATS) and renamed it the Princess Marina Hospital Accident & Emergency Triage Scale (PATS). Overall, over-triage rates and under-triage rates showed significant improvements, as PATS was more predictive of inpatient admission, Intensive Care Unit admission, and death in the ED than the prior triage system.
Study checklist key points:
• Objective: The Princess Marina Hospital Accident & Emergency (PMH A&E) leadership approached and partnered with the principal investigator, PM, to improve their triage system.
• Methodology: Using the adapted SATS allowed, a SATS team of trainers, that was available in the region, to assist in the training of trainers within the PMH A&E group.
• Culture and Partnerships: PM spent 2 years in Botswana working with physicians, developing partnerships and gaining familiarity with the local medical system and culture. A memorandum of understanding (MOU) was established between the senior hospital leadership in Botswana and PM’s sponsoring US institution. The role of PM in the project was to travel a few times per year from his home institution to organize the local staff in Botswana to design the project, build up local capacity to continue to manage it, and ensure its sustainability.
• Institutional Review Board and Ethics: All of the data collected and analyzed received approval from the IRBs of PMH, the Botswana Ministry of Health, the University of Botswana, and PM’s US home institution.
• Logistics: PM was able to secure funding for his travel from his home institution, the SATS trainers used their own funds to travel as an investment in their region’s healthcare, and the limited funding required for the rest of the project activities all came from resources within PMH which had a vested interest in improving its triage system and outcomes.
Developing this adapted triage system (PATS) fostered collaboration between two African countries as well as a US partner, and it promoted higher quality care for children with emergencies at the PMH A&E. This triage system is in year 5 as of 2014.