Evidence map›Paper›PMID 33007047›Full record

ArticlePloS one2020

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

Victor Lee, Dustin Dunsmuir, Stephen Businge, Robert Tumusiime, James Karugaba, Matthew O Wiens, Matthias Görges, Niranjan Kissoon, Sam Orach, Ronald Kasyaba and 1 more

Open access · goldAbstract readEvaluation Study
In one paragraph

Article in PloS one, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
10citing papers in PubMed, 1 pooled it
1.3field-weighted citation impact, top 18% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

10 citing papers in PubMed, 1 synthesis or guideline pooled it, 13 citations in OpenAlex.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors at 3 institutions in 2 countries.

Victor LeeDepartment of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada.ORCID 0000-0003-3198-9512
Dustin DunsmuirDepartment of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada.
Stephen BusingeHoly Innocents Children's Hospital, Mbarara, Uganda.
Robert TumusiimeHoly Innocents Children's Hospital, Mbarara, Uganda.
James KarugabaHoly Innocents Children's Hospital, Mbarara, Uganda.
Matthew O WiensSchool of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.
Matthias GörgesDepartment of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada.ORCID 0000-0003-2193-178X
Niranjan KissoonCenter for International Child Health, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada.
Sam OrachUganda Catholic Medical Bureau, Kampala, Uganda.
Ronald KasyabaUganda Catholic Medical Bureau, Kampala, Uganda.
J Mark AnserminoDepartment of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada.ORCID 0000-0001-8427-2035
University of British Columbia · CAHoly Innocents Children's Hospital · UGUganda Protestant Medical Bureau · UG

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundSepsis 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.

objectiveThis 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

designThe 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.

resultsThere 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).

conclusionA 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.

Indexed as

Quality ImprovementAdministration, IntravenousAdolescentAdultAnti-Bacterial AgentsChildFemaleHumansMaleMiddle AgedSepsisTime FactorsTriageUgandaYoung AdultAnti-Bacterial Agents

Identifiers

PMID33007047
PMCPMC7531789
OpenAlexW3089367550

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.