Regional scale-up of an Emergency Triage Assessment and Treatment (ETAT) training programme from a referral hospital to primary care health centres in Guatemala

Emerg Med J. 2016 Sep;33(9):611-7. doi: 10.1136/emermed-2015-205057. Epub 2016 May 20.


Objective: Emergency Triage Assessment and Treatment (ETAT) was developed by the WHO to teach paediatric assessment, triage and initial management to healthcare workers (HCWs) in resource-limited hospital-based settings. This study sought to evaluate the extension of ETAT training from a regional hospital to paediatric HCWs at local primary care health centres (PHCs) in Guatemala.

Methods: Prior to providing a 16 h ETAT training module, immediately after, and at 3, 6 and 12 months, we used written pre-tests and post-tests and five-point Likert surveys to evaluate, respectively, clinical knowledge and provider confidence in providing acute care paediatrics; hands-on clinical skills were tested at 3, 6 and 12 months.

Results: Fifty-two HCWs (14 general physicians, 38 nurses) from four regional PHCs participated; 65%, 60% and 46% completed 3-month, 6-month and 12-month follow-ups, respectively. Test scores show significant acquisition of clinical knowledge initially, which was retained over time when tested at 3, 6 and 12 months (46 vs 70, p<0.001). Hands-on clinical skills scores demonstrated retention at 3, 6 and 12 months. Although participants were more confident about acute care paediatrics immediately after training (66 vs 104, p<0.001), this decreased with time, though not to pre-intervention levels.

Conclusions: ETAT trainings were successfully extended to PHCs in a resource-limited setting with significant knowledge acquisition and retention over time and improved HCW confidence with acute care paediatrics. This process could serve as a successful model for in-country and international scale-up of ETAT.

Keywords: education, assessment; paediatrics, paediatric emergency medicine; triage.

MeSH terms

  • Clinical Competence
  • Developing Countries
  • Educational Measurement
  • Emergency Medicine / education*
  • Female
  • General Practitioners / education
  • Guatemala
  • Humans
  • Male
  • Nursing Staff, Hospital / education
  • Pediatrics / education*
  • Primary Health Care / organization & administration*
  • Prospective Studies
  • Referral and Consultation
  • Regional Medical Programs / organization & administration*
  • Triage*