Premier's Award win a “wonderful recognition of the value of partnership”
“This is really an award for my Papua New Guinean collaborators,” says FACEM Dr Rob Mitchell about receiving a 2023-24 Premier’s Award for Health and Medical Research. “The research would never have been possible without their enthusiasm and support. In particular, Dr John Junior McKup, Dr Carl Kingston, Dr Mangu Kendino, Dr Donna Piamnok, Dr Garry Nou, Dr Ovia Bue and Sr Wilma Sebby.”
Dr Mitchell received the Health Services Research Award in April, in recognition of his outstanding PhD research evaluating the acceptability and performance of the Interagency Integrated Triage Tool (IITT) in the Pacific region, both before and during the COVID-19 pandemic. It also examined the value of triage as a component of Pacific pandemic responses, as well as the impact of triage implementation on clinical outcomes within emergency departments in low- and middle-income countries.
Inside the ED at Mount Hagen Provincial Hospital, Papua New Guinea.
IITT is a triage tool that provides an integrated set of protocols for routine triage of children and adults and was developed in collaboration between the International Committee of the Red Cross (ICRC), Médecins Sans Frontières (MSF) and the World Health Organization (WHO).
The findings generated new knowledge around the IITT that resulted in the introduction of data management, novel triage and patient flow processes in several Pacific hospitals, leading to the triage tool being implemented across PNG and other Pacific Island countries.
Rob says, “It is such a privilege to be invited into another context, to collaborate with local colleagues, and to collaboratively work on improving emergency care systems. I have learnt a huge amount from Pacific Island clinicians as we have ventured on this research journey together.”
As one of just two public health researchers who received the prestigious honour, Rob describes the win as “an opportunity for me to acknowledge the incredible support I have received throughout this research program and my PhD journey”.
“ Importantly, he says, the project also “created an opportunity to develop a research partnership between Australian and Papua New Guinean clinicians”. ”
“From my family, from my supervisors Professor Peter Cameron and Associate Professor Gerard O’Reilly and from Australian colleagues – including FACEMs Colin Banks and Georgina Phillips, and emergency nurse Sarah Bornstein. It takes a village to win a Premier’s Award!”
Rob’s project – undertaken within his role at the School of Public Health and Preventive Medicine – is one that “grew organically” and expanded on previous research conducted by his FACEM colleague Georgina Phillips and expanded alongside Pacific collaborators.
“The research identified that triage was a high priority for the region. At about the same time, conversations with the acute care team at WHO in Geneva revealed that MSF, ICRC and WHO had been working together to devise a novel triage system for resource-limited settings. There was no published research on the performance of the tool, so we collectively realised there was an opportunity to implement and then rigorously evaluate it,” Rob says.
Importantly, he says, the project also “created an opportunity to develop a research partnership between Australian and Papua New Guinean clinicians”.
“This has been a collaborative effort from the outset, and a really rewarding and enjoyable one. It has been such a pleasure and privilege to work alongside Pacific colleagues, and I think we have all benefited from the experience.”
Dr Rob Mitchell with collaborators Dr Scotty Kandelyo (Port Moresby), Dr John Junior McKup (Mount Hagen) and Dr Colin Banks (Townsville) [R-L].
He describes the research as both practical and operational, adding that “although we were interested in assessing the validity of the IITT, we were also keen to support the implementation of an effective and efficient approach to ED triage in PNG”.
“It’s been a great model, because we have simultaneously been able to achieve both development and research objectives.”
Some of the biggest challenges to tackle were around conducting the research in PNG emergency departments – EDs Rob says are “under enormous pressure”.
“The demands for care are overwhelming, and staff are often in short supply. This created some challenges in implementing the new system, but also highlighted the value and necessity of effective triage.”
The fact that most of the research was conducted during the pandemic added another level of difficulty and meant that changing and adapting to evolving circumstances was an ongoing issue.
“ “It was only possible because a diverse range of organisations, including Papua New Guinean health services, ACEM, WHO and Monash University, collectively supported the research.””
“Travel restrictions created all sorts of challenges, but also forced us to find new ways of working,” Rob says.
“For instance, it created an opportunity to determine if smartphone-based digital learning (focused on triage training and implementation) would be feasible and effective in the PNG context. Local colleagues really embraced this novel approach. It proved to work extremely well, despite the challenges of poor internet connectivity in regional PNG.”
Rob acknowledges the IITT has “face validity”, but he says it was really important to determine its ability, in real-world settings, to identify patients with time-critical care needs.
“In this regard, the tool appears to perform as well as other more established triage systems, despite being simpler in its approach. Our research has verified that the tool is efficient to use and can be implemented with minimal training. These are really important characteristics in resource-limited settings.”
Seeing the IITT project scale-up over a few years, to be progressively studied and implemented across a range of PNG hospitals, has been positive – especially after its humble beginnings with a pilot study in a small, urban ED in Port Moresby.
In December 2023, a national 'training of trainers’ workshop was held.
“This means that local clinicians now have the knowledge and resources to implement the system without any external support, which is key to sustainability,” Rob says.
“The fact that it has been validated in the region, and found to be highly acceptable to Pacific clinicians, has really catalysed this process.”
Staff at Mount Hagen Provincial Hospital celebrate the completion of triage training.
Lessons for EDs in Australia and Aotearoa New Zealand
While Rob says the IITT was not designed for use in high-income country settings, “the results have made me wonder: would a simple, three-tier triage tool be safe and effective in the Australian and Aotearoa New Zealand context?”.
“This is something to be explored in the future.”
Rob’s gratitude to “the various donors who have contributed to the program by providing funding support for triage implementation” is something he says can’t be overlooked.
“This includes the ACEM Foundation and the Australian Government through the PNG-Australia Partnership.”
From a professional perspective, Rob says receiving the Premier’s Award for Health and Medical Research is “wonderful recognition of the value of partnership”.
He believes this collaborative model is “the key to success”, adding that he’s “proud that this project has provided a blueprint for future global emergency care research endeavours”.
“It was only possible because a diverse range of organisations, including Papua New Guinean health services, ACEM, WHO and Monash University, collectively supported the research,” Rob says.
“Importantly, it is testament to the value of Australian, Aotearoa New Zealand and Pacific clinicians working together to improve systems and outcomes of care”.
