Putting urgent care first: PNG nurses strengthen triage in Milne Bay
In a busy emergency department, recognising who should be seen most urgently is essential for prioritising care and preventing delays to treatment for patients with time-sensitive conditions. In August 2026, senior emergency nurses from Port Moresby supported colleagues at Alotau Provincial Hospital (APH) to put Papua New Guinea’s national Interagency Integrated Triage Tool (IITT) into practice, helping staff build the skills and confidence to prioritise patients by clinical urgency.
Led by experienced IITT trainers from Port Moresby Sr Betty Josaiah and Sr Jasper Pole, the visit combined practical training and clinical mentoring to strengthen emergency care. It demonstrates the value of PNG clinicians training and supporting their colleagues across the country for the improvement of existing policies and procedures.
Prioritising patients by urgency
Adopted as PNG’s national triage tool, the IITT uses three categories to prioritise patients according to how urgently they need treatment. Developed jointly by the World Health Organization, the International Committee of the Red Cross and Médecins Sans Frontières, it provides a consistent approach across health facilities.
Throughout the training, Sr Josaiah and Sr Pole emphasised that patients should be seen according to the urgency of their presentation, rather than their order of arrival. Participants were supportive of the approach, and were able to see the impact immediately, noting:
“The IITT… helps solve or ease a backlog of patients waiting their upon first contact with a health care worker. Patients were happy to be attended to immediately, smiled when being attended to by their names and were alert to when they will be called next.”
During supervised practice, participants described more organised care, clearer staff roles and improved communication. These early reflections offer insight into how staff experienced the new approach and the support needed to embed it.
APH Emergency Physician Dr Mataio highlighted the potential for a consistent approach to strengthen emergency care:
“The new IITT system at APH will improve emergency care delivery and provide all staff with a uniform system to support patient flow and improve capacity of the ED.”
Participants were also clear about what would help sustain these changes. They identified staffing shortages, limited space and equipment, printing requirements and transport delays for urgent referrals. Their feedback reinforces the importance of combining training with ongoing mentoring and improvements to the systems and resources that support care.
Nurse-led learning, grounded in practice
Sr Josaiah and Sr Pole worked alongside Dr William Mataio and Emergency Department Nurse Unit Manager Mr Patrick Patrick, training 37 clinical staff from the emergency department, other hospital departments and the nearby urban clinic. Participants were supported to apply their learning directly to their own practice in the workplace through group discussions, roleplays and in-person mentoring.
Those involved highlighted both the practical approach and the supportive learning environment created by the nurse trainers:
“Live sessions today in real time was very engaging and rewarding seeing what we learned being put into action.”
“I just love the interaction between the facilitators and the participants.
The facilitators are so friendly.”
Sr Pole emphasised the importance of applied training led by nursing staff from within PNG:
"Having an opportunity to gain additional evidenced based knowledge and skill in our home soil; tailored to our PNG setting and at the same time being mentored motivates and encourages our fellow health worker colleagues and ancillary staff to feel confident”
Building local capacity through connection
Sr Josaiah described the value of connecting emergency care clinicians within PNG:
“This is more than just implementing IITT, it's about building strong professional networks and local capacity. Connecting emergency care clinicians across PNG provides an opportunity to share knowledge, experience and practical solutions that strengthen our healthcare system.”
The visit also connected the Alotau team with remote expertise. PNG emergency physician Dr Carl Kingston provided an adapted dashboard for data entry and joined a live online session to share the experience of Port Moresby General Hospital’s emergency department in implementing a data collection system. The dashboard supports closer monitoring of patient presentations, including demographics and time spent in the emergency department, to inform ongoing quality improvements.
Local staff from APH stepped into teaching roles, with Sr Pole described how these new IITT trainers took part in training their own colleagues, generating enthusiasm for further learning. She emphasised the value of shared language and a safe space to discuss challenges and develop solutions together:
“It’s another way of team bonding and strengthening. It really ignited a fire for more training amongst them.”
The visit received strong support from hospital leadership, the Milne Bay Provincial Health Authority and the wider community. Alotau Mayor Hon. Esmond Basinauro and Dr Dale Frank, Director for Curative Health Services and Acting Chief Executive Officer of Alotau Provincial Hospital, attended the official launch.
Looking to the future, Dr Mataio added;
“The IITT is a step forward to improving emergency care systems in the Milne Bay Provincial Health Authority. As well as improving emergency care in the provincial hospital, we trust that the system will also be taught and implemented to other lower levels of care- levels three and four facilities, in the near future.”
RECSI is supporting local colleagues in PNG to extend the delivery of outreach visits to other provincial facilities across PNG, including areas without specialist emergency clinicians. By connecting experienced PNG emergency nurses and doctors with provincial teams, the program continues to support the ongoing development of local capacity and supports improvements tailored to each facility’s needs and resources.
RECSI is funded by the Australian Government through the Partnerships for a Healthy Region initiative. Local partner National St John Ambulance PNG provided coordination and logistical support for the visit.
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