Triage in Preventive Child Healthcare: A novel triage protocol to identify health problems in primary school children: abstract

Background. A triage approach to routine health assessments was recently introduced to improve the efficiency of Preventive Child Healthcare (PCH) in the Netherlands: PCH assistants carry out pre-assessments of all children and send the children with suspected health problems to follow-up assessments conducted by a physician or nurse. This two-step approach differs from the usual approach, in which physicians or nurses assess all children. Previously, each PCH service that employs a triage method used their own criteria (i.e. protocol) to determine whether a follow-up assessment is needed. Health themes such as visuals disorders, sleeping problems and psychosocial problems are generally included in the protocol. This study aimed to improve the quality of detection of health problems in primary school children by PCH by developing a standardized triage protocol, and by investigating the quality of detection of health problems of this novel protocol. Methods. A systematic approach was used to develop the standardized triage protocol, e.g. by making use of an assessment framework and an expert group. Data was gathered by PCH services, using both parent-reported child problems and PCH registry data. After each routine assessment PCH professionals reported whether they had identified any problems in the child and carried out additional actions (e.g., additional assessments, referral). We will assess the validity of the protocol (sensitivity and specificity), with problems identified by PCH professionals as well as additional actions by the professional as criteria (gold standard). Next, the satisfaction with the novel protocol will be investigated among parents and PCH professionals; the answers of parents on a questionnaire will be analyzed and PCH professionals will be interviewed. Results. We included 670 primary school children undergoing routine health assessments in 4 PCH services across the Netherlands. Validity of the protocol and satisfaction with the novel protocol of parents and PCH professionals will be assessed in the spring, and presented at the EUSUHM congress. Conclusions. Conclusions will be drawn about whether the novel triage protocol is a valid method to identify health problems in a PCH setting. Recommendations about necessary adaptations of the protocol and the need of future research will be made.