Evaluation of a digital triage platform in Uganda: A quality improvement initiative to reduce the time to antibiotic administration

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Evaluation of a digital triage platform in Uganda: A quality improvement initiative to reduce the time to antibiotic administration


JournalPlos One
Publication date – Oct – 2020
Authors – Victor Lee, Dustin Dunsmuir, Stephen Businge, Robert Tumusiime, James Karugaba, Matthew O. Wiens, Matthias Görges, Niranjan Kissoon, Sam Orach, Ronald Kasyaba, J. Mark Ansermino
KeywordsSepsis, triage
Open access – Yes
SpecialityEmergency surgery, Health policy, Other
World region Central Africa, Eastern Africa
Country: Uganda
Language – English
Submitted to the One Surgery Index on October 21, 2020 at 8:50 am
Abstract:

Background
Sepsis is the leading cause of death in children under five in low- and middle-income countries. The rapid identification of the sickest children and timely antibiotic administration may improve outcomes. We developed and implemented a digital triage platform to rapidly identify critically ill children to facilitate timely intravenous antibiotic administration.

Objective
This quality improvement initiative sought to reduce the time to antibiotic administration at a dedicated children’s hospital outpatient department in Mbarara, Uganda.

Intervention and study design
The digital platform consisted of a mobile application that collects clinical signs, symptoms, and vital signs to prioritize children through a combination of emergency triggers and predictive risk algorithms. A computer-based dashboard enabled the prioritization of children by displaying an overview of all children and their triage categories. We evaluated the impact of the digital triage platform over an 11-week pre-implementation phase and an 11-week post-implementation phase. The time from the end of triage to antibiotic administration was compared to evaluate the quality improvement initiative.

Results
There was a difference of -11 minutes (95% CI, -16.0 to -6.0; p < 0.001; Mann-Whitney U test) in time to antibiotics, from 51 minutes (IQR, 27.0–94.0) pre-implementation to 44 minutes (IQR, 19.0–74.0) post-implementation. Children prioritized as emergency received the greatest time benefit (-34 minutes; 95% CI, -9.0 to -58.0; p < 0.001; Mann-Whitney U test). The proportion of children who waited more than an hour until antibiotics decreased by 21.4% (p = 0.007).

Conclusion
A data-driven patient prioritization and continuous feedback for healthcare workers enabled by a digital triage platform led to expedited antibiotic therapy for critically ill children with sepsis. This platform may have a more significant impact in facilities without existing triage processes and prioritization of treatments, as is commonly encountered in low resource settings.

OSI Number – 20689

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