Perceptions and challenges of using emergency triage assessment treatment guideline in emergency department at Muhimbili national hospital, Tanzania

Abstract

Background: Triage is the process of determining the priority of patients' treatments based on the severity of their conditions. This helps treating patients efficiently when resources are insufficient for all to be treated immediately. Health care providers use ETAT guideline during triaging patients to improve quality of care and reduce morbidity and mortality rates. But the adherence to the guidelines protocol has been a challenge in triage rooms. This paper assessed perspective of HCWs and challenges encountered while using ETAT guideline. Objective: The objective of this study was to explore nurses and doctors‘ perspectives and challenges they encounter during implementation of the ETAT guideline used to triage patients with different categories at Muhimbili National Hospital. Methodology: This study employed a descriptive qualitative design to obtain thick and rich data. Focus group discussions were used to explore nurses and doctors‘ perspectives and challenges they encounter during implementation of ETAT guideline in the emergency department at Muhimbili National hospital. The questions included sections on socio-demographic data, working experience, HCWs perspective, challenges they encounter during the triage process. Results: In this study, there were five categories; Guideline is useful in triaging with comparison to the situation before it was introduced; unbalanced patient-staff ratio; challenges to implementation of ETAT Guideline; knowledge deficit and disagreement among health care workers; lack of motivation and negative attitude towards professionalism under one theme ―the ETAT guideline has improved the triaging process but have many challenges hindering its successful implementation‖. In this study, Informants expressed the usefulness of ETAT guideline. There were several challenges to the implementation and they included unbalanced patient/staff ratio, fear of employee leaving the unit due to work overload which vii makes the triage process to become difficult. Another challenge was equipments which are not functioning and others giving unreliable findings. Participants said that the ETAT guideline does not explain how psychiatric emergencies should be triaged and managed leaving the triage nurse in dilemma in decision making. Respondents reported that there were some complains from patients and relatives waiting in queue about delays of care. Respondents reported that nurses and doctors are less motivated in terms of salary, recognition and appreciation by employer was mentioned as a negative impact on their work resulting into unmet expectation. Conclusion In this study, challenges mentioned were equipments which are not functioning example monitors, machine giving unreliable/different results resulting in delays in delivering care to patients. Unbalanced staff/patient ratio was mentioned as a barrier to implementation. The study shows knowledge deficit on how to categorize patient according to the guideline, also there was disagreement between nurses and doctors on the use of Guideline. Less motivated workers in terms of payment, recognition and appreciation was said to have significant implication in the implementation of the guideline. Another concern was some workers lacking positive attitude towards their profession. Recommendations: Increasing number of health care workers by hiring new employees will improve workload will improve triaging and increase patient satisfaction. Government need to train more specialists in emergencies to provide maximum quality of care. On job training of workers on how to use the guideline will improve the triage protocol. Maintenance of non functioning equipments and purchase of new materials will increase the productivity of quality of care. Motivating those on duty by providing salary which is equivalent to the work accomplished, appreciating job well done and recognition of workers who have achieved maximum tasks will increase job satisfaction.