Mitchell, Rob, Bornstein, Sarah, Piamnok, Donna, Sebby, Wilma, Kingston, Carl, Tefatu, Rayleen, Kendino, Mangu, Josaiah, Betty, Pole, Jasper, Kuk, Sylvia, Körver, Sarah, Miller, Jean Philippe, Cole, Travis, Erbs, Andrew, O'Reilly, Gerard, Cameron, Peter, Sengiromo, Duncan, and Banks, Colin (2023) Multimodal learning for emergency department triage implementation: experiences from Papua New Guinea during the COVID-19 pandemic. The Lancet Regional Health - Western Pacific, 33. 100683.

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Abstract

Background: Triage implementation in resource-limited emergency departments (EDs) has traditionally relied on intensive in-person training. This study sought to evaluate the impact of a novel digital-based learning strategy focused on the Interagency Integrated Triage Tool, a three-tier triage instrument recommended by the World Health Organization.

Methods: A mixed methods study utilising pre-post intervention methods was conducted in two EDs in Papua New Guinea. The primary outcome was the mean change in knowledge before and after completion of a voluntary, multimodal training program, primarily delivered through a digital learning platform accessible via smartphone. Secondary outcomes included the change in confidence to perform selected clinical tasks, and acceptability of the learning methods.

Findings: Among 136 eligible ED staff, 91 (66.9%) completed the digital learning program. The mean knowledge score on the post-training exam was 87.5% (SD 10.4), a mean increase of 12.9% (95% CI 10.7–15.1%, p < 0.0001) from the pre-training exam. There were statistically significant improvements in confidence for 13 of 15 clinical tasks, including undertaking a triage assessment and identifying an unwell patient. In an evaluation survey, 100% of 30 respondents agreed or strongly agreed the online learning platform was easy to access, use and navigate, and that the digital teaching methods were appropriate for their learning needs. In qualitative feedback, respondents reported that limited internet access and a lack of dedicated training time were barriers to participation.

Interpretation: The use of digital learning to support triage implementation in resource-limited EDs is feasible and effective when accompanied by in-person mentoring. Adequate internet access is an essential pre-requisite.

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