Triage systems in low-resource emergency care settings.

Abstract

Triage is widely regarded as a core emergency care function, as reflected in the World Health Organization (WHO) Emergency care systems framework and in recent World Health Assembly resolutions. In this article, we explore the evidence supporting triage in low-resource settings, with a focus on the Interagency Integrated Triage Tool. Following its release by WHO in the early stages of the coronavirus disease pandemic, the tool has been implemented across a range of low- and middle-income countries. We report evidence regarding its acceptability and performance from Papua New Guinea in the WHO Western Pacific Region. Data from four single-centre studies suggest that the tool can be reliably and efficiently applied by health workers, and its predictive validity is within the performance range of other triage instruments. The system is highly regarded by emergency care clinicians, and can be implemented with limited digital or in-person training. Although triage has intuitive and widely acknowledged value, recent research has identified a lack of high-quality evidence supporting an association between triage implementation and improved clinical outcomes. Evidence from several pre-post intervention studies suggests that the introduction of triage can reduce waiting times and mortality, but these data may have been subject to confounding and publication bias. Further research is required to establish the performance characteristics of the Interagency Integrated Triage Tool in other countries and contexts, and more rigorously examine the impact of triage implementation on quality of care.