Navigating the Interagency Integrated Triage Tool (IITT) at Port Moresby General Hospital’s Children’s Emergency Department (CED) involves an understanding of its origins, patient flow management, and the triage process. Since its introduction at the CED in December 2023, the IITT has been instrumental in enhancing the efficiency of emergency care at Port Moresby General Hospital, building upon its adaptation from adult EDs to include pediatric patients.
The IITT, developed collaboratively by the World Health Organization (WHO), International Committee of the Red Cross (ICRC), and Médecins Sans Frontières (MSF), serves as a structured system to swiftly assess and categorize patients based on the severity of their health issues. This tool was initially piloted at Gerehu and Mount Hagen Hospitals’ Emergency Departments in Papua New Guinea (PNG), laying the groundwork for its implementation at Port Moresby General Hospital.
Upon arrival at the CED, patients are promptly assessed by a triage officer using the IITT, who then directs them accordingly to their designated category: Red Criteria (Category 1), Yellow Criteria (Category 2), or Green Criteria (Category 3). Each category dictates the urgency of the patient’s condition and determines the subsequent course of action. For instance, Category 1 patients, requiring immediate attention, are directed to the resuscitation area, while Category 3 patients, with less urgent issues, may wait in the waiting area or be directed to the fast-track area for expedited evaluation and treatment.
It’s important to note that patients are encouraged to utilize local urban clinics for less severe cases, alleviating pressure on the CED and reducing waiting times for Category 3 patients. This strategy optimizes healthcare resource allocation and ensures that critical cases receive priority attention.
Examples of conditions corresponding to each triage category include:
- Red Criteria (Category 1): Immediate medical response needed within 5 minutes. This category includes conditions such as severe respiratory distress (e.g., stridor, central cyanosis), unresponsiveness, active convulsions, or severe circulatory compromise (e.g., heavy bleeding, capillary refill >3 seconds).
- Yellow Criteria (Category 2): Response required within 30 minutes for serious conditions that are not immediately life-threatening. This includes issues like moderate respiratory problems (e.g., wheezing), severe dehydration symptoms, or severe pain and continuous irritability.
- Green Criteria (Category 3): Response within 2 hours for less urgent medical issues, which may include mild dehydration, restlessness, minor rashes that are not weeping, or common cold symptoms.
In the fast-track area, Category 3 patients can wait to receive treatment, typically seated on a bench due to limited bed availability. These patients, predominantly consisting of gastroenteritis cases requiring rehydration and respiratory patients needing nebulizers, are generally expected to spend less than 24 hours in the CED. Despite their illness, they are deemed well enough to occupy bench seating, reflecting the efficient utilization of resources within the department
By adhering to the principles of the IITT and effectively managing patient flow, Port Moresby General Hospital’s CED ensures that all patients receive timely and appropriate care, maintaining equilibrium between demand and availability in the face of increasing population strain on the healthcare system.
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