660 - Delays in Registration and Triage of Children with Severe Pneumonia in Emergency Rooms in Addis Ababa, Ethiopia: A Multicenter Qualitative Study

Publication Number: 3639.660

Jesse JudahBram, Stanford University, Marysville, WA, United States; Aboneh Solomon. Sime, Addis Ababa University, School of Public Health, Addis Ababa, Adis Abeba, Ethiopia; Yordanos Tadesse. Kidanemariam, Addis Ababa university, Addis Ababa, Adis Abeba, Ethiopia; Sylvia Bereknyei Merrell, Stanford University School of Medicine, Stanford, CA, United States; Amanuel Moges Haile, Addis Ababa University, Addis Ababa, Adis Abeba, Ethiopia; Tigist Bacha, St Paul's Hospital Millenium Medical College, Addis Abeba, Adis Abeba, Ethiopia; Muluwork Dinberu. Tefera, Addis Ababa University, Addis Ababa, Adis Abeba, Ethiopia; Chris A. Rees, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, United States; Michael A. Gisondi, Stanford University School of Medicine, Palo Alto, CA, United States; Lulu M. Muhe, Addis Ababa University, MEYRIN, Geneve, Switzerland; Mirgissa Kaba. Serbessa, School of Public Health, Addis Ababa University, Addis Ababa, Adis Abeba, Ethiopia; Rishi P. Mediratta, Stanford University School of Medicine, Stanford, CA, United States

Background: Pneumonia causes over 610,000 under-five deaths each year, mostly in low- and middle-income countries, and ranks second among causes of child mortality in Ethiopia. Many of these deaths are preventable through timely and high-quality emergency care. System-level delays in emergency rooms (ERs) contribute to suboptimal clinical care and child mortality, yet the contextual factors driving these delays remain poorly understood.

Objective: Explore system-level factors contributing to registration and triage delays for children with severe pneumonia in ERs in Addis Ababa, Ethiopia.

Design/Methods: We conducted semi-structured interviews with caregivers of children under five years hospitalized with severe pneumonia at three referral hospitals in Addis Ababa, as well as with administrators at the hospital, city, and Ministry of Health levels. We also held focus groups with ER healthcare providers at the same three hospitals. Interview and focus group guides were developed to explore delays in administering clinical care in the ER, translated into Amharic, and back-translated. After obtaining written consent, interviews and focus groups were recorded, transcribed, translated, and independently double-coded using an inductive approach by a team of three researchers. Differences were resolved through discussion (intercoder agreement 88%). Themes were derived using inductive thematic analysis.

Results: 30 caretakers, 78 healthcare providers, and 23 administrators participated in the study (Tables 1 and 2). Four themes were identified from the codes (Table 3). Findings revealed that a limited number of healthcare providers, overwhelmed by patient volume, led to delays in registering and triaging children. Furthermore, undertraining healthcare providers in emergency triage led to variability in triage quality. Also, disjointed ER infrastructure and processes created unsafe conditions, at times forcing caregivers to disconnect their children with severe pneumonia from oxygen to complete registration. Lastly, caregiver payment processing systems prior to the clinical evaluation contributed to delays, which postponed physicians' assessments.

Conclusion(s): This multicenter qualitative study exposes system-level barriers that operate in tandem to delay the registration and triage of children with severe pneumonia in ERs, affecting the timeliness and quality of service provision. Strengthening workforce capacity about emergency triage, streamlining payment and registration processes, and upgrading hospital infrastructure are essential to reducing delays, improving emergency care, and reducing preventable pneumonia deaths.

Table 1: Demographic Characteristics of Caregivers of Children with Severe Pneumonia (n=30), Addis Ababa, Ethiopia


Table 2: Demographic Characteristics of Healthcare Providers (n=78) and Administrators (n=23), Addis Ababa, Ethiopia


Table 3: Themes and Selected Quotations
The four themes identified as factors contributing to delays in registering and triaging children with severe pneumonia in three emergency rooms in Addis Ababa, Ethiopia