Text box 1 Needs assessment — reflections and lessons learned from VCH

Prior to the initiation of this project, improving triage and referral processes had been identified as a priority for the Vanuatu Ministry of Health and VCH [20, 22]. To ensure that all stakeholders had a shared understanding of the contemporary model of care and case mix in the ED, local and visiting clinicians collaboratively completed the EDSAT.

The EDSAT was administered by a visiting nurse advisor and local ED clinicians. Completing the proforma allowed the group to identify that, alongside triage training, a number of other systems improvements would be required. For instance, the process resulted in reallocation of the clinical space dedicated to resuscitation, to better align with the IITT’s patient flow principles. It also highlighted the potential gains that would come from integration of the existing outpatient department with the ED, to ensure a consistent model of care at the ‘front door’ of the hospital.

Completing the EDSAT emphasised the need for a holistic and multidisciplinary approach to the patient care journey. It affirmed the importance of including the local ambulance service in training and systems changes, and the need for positive engagement with inpatient wards to support effective patient flow into and out of the ED.

Finally, the EDSAT identified the need to optimise nursing staffing to ensure that a nurse could be allocated to the triage role for each shift, as well as each of the care streams implemented as part of the new model (resuscitation, acute and fast track). It also reinforced the need for local ‘champions’ to lead the quality improvement process. Although workforce reform was beyond the scope of the triage project, the EDSAT highlighted the interconnectedness of different emergency care building blocks (i.e., that improving ‘processes’ is also dependent on ‘human resources’ and ‘leadership and governance’.).