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Key messages What is already known on this subject?
Rapid identification and stabilisation of acutely ill children decreases morbidity and mortality.
Multiple barriers exist in low/middle-income countries (transportation, poverty, overwhelmed healthcare system) that make rapid emergency care challenging.
Emergency Triage Assessment and Treatment (ETAT)-based triage systems have improved patient and process outcomes in Africa and Latin America in hospital settings; utility in primary care settings is unknown.
What might this study add?
Spanish ETAT (Clasificación, Evaluación y Tratamiento de Emergencias Pediatricas) can successfully be used to train providers in a primary healthcare setting.
Providing the knowledge, skills and confidence for initial identification and management of acutely ill children in the primary care setting may be lifesaving to a much larger population than hospital-based interventions alone.
Background
The Emergency Triage Assessment and Treatment (ETAT) guidelines were developed by the WHO as part of the Integrated Management of Childhood Illnesses programme to promote improved assessment, triage and initial management of acutely ill children in resource-limited hospital-based settings. 1-3 Early recognition and stabilisation of ill children is known to improve outcomes 4-12 but is contingent upon implementing effective triage, following clinical guidelines, and providing supervision and monitoring of patients 13 14 to work towards the Millennium Development Goal of decreasing child mortality. 15
As part of a collaborative effort among Hospital Nacional Pedro Bethancourt (a public hospital in La Antigua, Guatemala, henceforth called 'the referral hospital'), the Guatemalan Ministry of Health ('the Ministry'), the Pan-American Health Organization and Baylor College of Medicine/Texas Children's Hospital (BCM/TCH), we developed and implemented a locally led, self-sustaining, high-quality and effective Spanish ETAT (Clasificación, Evaluación y Tratamiento de Emergencias Pediatricas (CETEP)) training programme at the referral hospital starting in May 2010. 16 Since then, the referral hospital has trained >450 healthcare workers (HCWs) in CETEP (ETAT) and subsequently implemented a formal CETEP (ETAT)-based triage process in the paediatric emergency department (PED) in collaboration with BCM/TCH that has positively impacted clinical outcomes of paediatric patients at their institution. 12
Leaders at the referral hospital identified the next step in quality improvement (QI) as extension of CETEP (ETAT) trainings to HCWs in primary care health centres (PHCs) within their region in Guatemala. Although initially designed for hospital-based settings, the low-tech/high-impact ETAT system of patient classification...