Evaluating the Triage of Suspected COVID-19 Cases in Sudan’s Emergency Settings: A Clinical Audit

Abstract

Background

The inevitable coronavirus disease 2019 global pandemic has severely affected Sudan’s fragile healthcare system. The authors share the experience of COVID-19 triage in the emergency departments of five public hospitals in Khartoum state, Sudan.

Methods

A clinical audit was conducted in December 2020 using the Centers for Disease Control and Prevention Checklist and Monitoring Tool for Triage of Suspected COVID-19 Cases. The tool was categorised into 5 domains and 38 indicators.

Results

Only three hospitals had hand hygiene stations in their triage areas: Ibrahim Malik, Omdurman, and Al-Nau. Omdurman Teaching Hospital was the sole hospital with a designated respiratory waiting area. At Al-Nau and Omdurman Hospitals, all respiratory symptomatic patients wore a facemask or alternative. Ibrahim Malik and Bahri Teaching Hospitals had 60% and 50% compliance, respectively, while none at El-Tamayouz Hospital did. No posters or job aids were present in donning and doffing areas. Heavy duty gloves were worn only at Ibrahim Malik (50%) and Omdurman (20%). 100% of staff wore closed-toe footwear at Ibrahim Malik and Omdurman, 75% at El-Tamayouz, 63% at Bahri, and none at Al-Nau.

Conclusion

The healthcare facilities displayed significant shortcomings in preparedness and response to COVID-19, with variations across hospitals in infrastructure, human resources, and procedures. To better combat future outbreaks, systemic improvements and a focused approach on consistent staff training, standard triage algorithms, and adequate PPE availability are imperative.

Keywords:

• severe acute respiratory syndrome coronavirus 2
• SARS‑CoV‑2
• coronavirus disease 2019
• COVID-19
• triage
• emergency departments
• Sudan

Abbreviations

ACEP, American College of Emergency Physicians; CDC, Centers for Disease Control and Prevention; COVID-19, coronavirus disease 2019; EDs, Emergency Departments; ER, Emergency room; ERCs, Emergency response centres; HCPs, Healthcare personnel; ICP, Infection prevention and control; LMICs, Low and Middle-Income Countries; MSF, Médecins Sans Frontières; PPE, Personal protective equipment; SARS‑CoV‑2, Severe acute respiratory syndrome coronavirus 2; SSA, sub-Saharan Africa.

Data Sharing Statement

All data generated or analysed during this study are included in this published article.

Ethics Approval

The study was approved by the ethical committee of the Department of Community Medicine, University of Khartoum (Reference Number 1/2022Com.med). Consent for participation was not applicable as the study did not involve any human participants or any data that could lead to human identification.

Acknowledgments

We would like to thank Dr. Elfatih Malik for his expertise and assistance throughout all aspects of our study.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors declare that they have no competing interests.