Prioritising the care of critically ill children: a pilot study using SCREEN reduces clinic waiting times

Area of Science:

• Global Health
• Pediatric Emergency Medicine
• Healthcare Management

Background:

• Childhood mortality in low-resource settings is exacerbated by delays in triage and treatment.
• Primary healthcare clinics face challenges in managing critically ill children due to long waiting times.

Purpose of the Study:

• To evaluate the impact of the Sick Children Require Emergency Evaluation Now (SCREEN) tool on waiting times for critically ill children.
• To assess the effectiveness of SCREEN in primary healthcare clinics in Cape Town, South Africa.

Main Methods:

• A pre/post-evaluation study design was employed.
• Median waiting times were calculated for children presenting to four randomly selected clinics.
• Data were collected over 5-day periods before and after SCREEN implementation.

Main Results:

• SCREEN significantly reduced waiting times for critically ill children to see a nurse (from 2h 45min to 1h 12min).
• The proportion of children leaving without being seen decreased significantly (from 25.8% to 18.48%).
• Statistical significance was achieved with p<0.001 for both outcomes.

Conclusions:

• The SCREEN tool offers a novel, low-cost, and simple methodology for prioritizing children in primary healthcare settings.
• It effectively reduces waiting times, addressing a critical gap in low-resource healthcare.
• Trained laypersons can successfully implement subjective assessments to improve patient flow.