Terms of Reference

For International Advisory services

on the development of an in-patient assessment system for the severity of the condition and sorting standards (triage) at the stationary stages under the project "Emergency medical services project"

 

 

Position:	Short-time international consultant in project implementation country
Project:	Emergency medical services project
Organization:	World Bank Ministry of Health of the Republic of Uzbekistan Project Implementation Unit under the Republican Scientific Centre of Emergency Medical Aid

 

 

 

 

 

 

 

 

 

1. Premise

 

Within the framework of the loan agreement No. 6210-UZ between the Republic of Uzbekistan and the International Development Association (IDA), the project “Emergency medical services project (EMSP)” is being implemented, aimed at strengthening and developing the material and technical base of the Republican Scientific Center for Emergency Medical Aid (RSCEMA), its regional branches and offices in district (city) medical associations, as well as the improvement of dispatcher, communication and information systems of EMA.

 

    As part of the project component (Component 1: Creating favorable conditions for EMS, managing the system and improving the quality of EMS), a number of interrelated measures will be carried out to reorient the EMS to provide high-quality emergency medical aid. Funding for technical assistance, training, study tours, surveys and equipment has been planned.

 

This component includes subcomponent 1.1: Regulation, management and operational management, created to implement the concept of EMS, to manage the implementation and functioning of the system with the development of EMS regulatory framework. The subcomponent will also help in operational management capacity building at all levels of the EMS, including in the areas of HR management, budget management and data-driven decision-making. Protocols will be developed and updated for dispatchers and operational ambulance crews to direct their activities in accordance with the established concept for the development of the EMS, as well as in the development of both pre-hospital and in-patient triage and a system for assessing the severity of the condition, which will be important to ensure the focus of the EMS, mainly on emergency cases.

According to the approved feasibility study, it is planned to hire an international consultant to develop an in-patient assessment system for the severity of the condition and sorting standards (triage) at the stationary stages.

2. Scope of consulting services.

Purpose of Assignment: Development of scientifically based principles for the in-patient sorting of patients according to the severity of the condition in the reception department of EMS hospitals.

For the purposes of the Project, the Project Implementation Unit (PIU) invites an experienced specialist to perform the following types of work:

• Analysis of the existing situation, international experience and best practices for developing a model for inpatient sorting of incoming patients, as well as a system for assessing the severity of the patient's condition, which play an important role in ensuring focus mainly on ambulance, emergency and urgent cases.
• Providing advice on the development of a sorting algorithm that provides a clinically significant division of patients into groups.
• Providing advice on the development of decision-making algorithms in the reception department (discharge home, to the department or to the intensive care unit, transfer to another institution), including calculating the transportation time taking into account the patient's condition, the appropriate mode of transport and communication between institutions and departments.
• Review of existing sorting standards (triage) to comply with their current regulatory documents of the emergency medical service system.
• Assistance to international and local consultants in the joint development of activities of the training subcomponent of the project aimed at reviewing and revising the existing training programs at the pre-diploma level and advanced training at the postgraduate level.
• Conduct a review of best practices in this area and provide recommendations for study tours indicating the country and the specific medical institution to study the best international experience.
•  

Expected results:

An international consultant will work with a local consultant to provide results and reports.

The estimated perimeter of consulting services involves obtaining the following results:

 

	Work Stages and Expected Results		Deadline
1	Work plan of an international consultant.     Analysis of the existing situation, international experience and best practices for developing a model for inpatient sorting of incoming patients, as well as a system for assessing the severity of the patient's condition, which play an important role in ensuring focus mainly on ambulance, emergency and urgent cases.	The work plan of the international consultant with the deadlines and dates of visits of Uzbekistan.   Analytical Report - Situation Analysis (rus + eng)
2
3	Providing advice on the development of decision-making algorithms in the reception department (discharge home, to the department or to the intensive care unit, transfer to another institution), including calculating the transportation time taking into account the patient's condition, the appropriate mode of transport and communication between institutions and departments.	A document with proposals for the development of a sorting algorithm (Rus + Eng)
4	Review of existing grading standards (triage) to comply with their current regulatory documents of the emergency medical service system.	Report on compliance of sorting standards with regulatory documents (rus + eng)
5	Assistance to international and local consultants in the joint development of activities of the training subcomponent of the project aimed at reviewing and revising the existing training programs at the pre-diploma level and advanced training at the postgraduate level.	Recommendations on the results of the curriculum revision (Rus + Eng)
6	Conduct a review of best practices in this area and provide recommendations for study tours indicating the country and the specific medical institution to study the best international experience.	List of countries for study tours
7	Formation of a detailed report with a package of documents, including updated, agreed upon clinical standards for a point assessment of the severity of the case (triage) at the stationary stages.	Final report approved in the established manner (Russ + eng)

 

3. Qualification requirements:

 

General requirements

The consultant should have relevant experience at the international level in developing a system of an in-patient assessment of the severity of the condition and sorting standards (triage) at the stationary stages of EMS provision, preferably, or in related matters, including in Central Asia and/or Eastern Europe. A high level of knowledge of oral and written English is mandatory; knowledge of the Russian language will be an advantage. It is also important to have interpersonal skills. In preparing complementary aspects of the Emergency Medical Services Project, the consultant should work closely with other international and national consultants.

 

Key qualifications and investments of a consultant

The consultant must have proven experience in the development of triage, namely, the system for determining the priority of medical service in the hospital if there are a large number of patients, but a limited number of medical personnel and means of transportation, as well as the creation of a system for assessing the severity of the patient's condition at the stationary stage of EMS.

 

The consultant should have:

• higher education in the relevant field (medicine, health management or other related field);
• at least 10 years of practical experience in the relevant field (emergency medical service, health management or equivalent), including systematic reviews;
• knowledge of international sorting standards, including a system for assessing the severity of the patient's condition at the stationary stage of the EMS.
• experience in projects funded by the World Bank, the European Commission or other donor organizations is an advantage;
• fluency in English, knowledge of the Russian language is an advantage, knowledge of working skills in text editing programs, spreadsheets, e-mail, graphic programs.

 

4. Deliverable:

 

The consultant should submit all reports in English and Russian:

 

Preliminary report, at the end of the first visit	Content: Work plan for an international consultant with a description of the mechanism for implementing assignments. Situational analysis / analytical report of the current situation, international experience and best practices for developing a model for stationary sorting of incoming patients, as well as a system for assessing the severity of the patient's condition.
Interim report: after the second visit	An algorithm for sorting decision-making in the reception department, including calculating the transportation time taking into account the patient's condition, the appropriate mode of transport, and communication between institutions and departments providing a clinically significant division of patients into groups. Report on compliance of sorting standards with regulatory documents. Recommendations for study tours indicating the country and specific medical institution.
Final report (2 weeks after completion of work)	A final report containing all the points listed above, and detailed recommendations for any additionally recommended or proposed areas for improving the quality of EMS.

 

• The consultant is accountable to the Republican Scientific Center of Emergency Medical Aid (RSCEMA) and the PIU “Emergency Medical Services Project”. The consultant should base his report and take into account all aspects of ToR, noting key issues.

 

• The consultant should provide the following summary reports:

• Preliminary report on planned work with a description of the mechanism for completing tasks (2-4 weeks after the start of work).
• Final activity report - within 10 business days after completion of work.
• All reports must be submitted to the PIU “Emergency Medical Services Project” Executive Director (electronic version + hard copy) in English and Russian. The PIU must approve all reports within 10 business days.

 

• All correspondence with the Government and other departments related to the Project should be sent through the PIU Executive Director. The Final Report and other documents prepared by the consultant should be submitted to the PIU Executive Director (electronic version + hard copy) in Russian and English. The PIU must approve the reports within 10 business days after the report is agreed with the expert commission of the Ministry of Health.

 

The duration of the provision of services:

The consultant will provide its services within 2 months in I-II quarter 2020 according to the schedule agreed with the Client.  

Client’s inputs:

The PIU will provide the consultant with a furnished office space, access to document reproduction equipment and local communication services, including the Internet. The consultant should have his own laptop for use during the service period. In addition, the PIU will provide relevant materials and reports through an expert working group, help establish contacts with various interested organizations / institutions, and organize meetings with representatives of interested groups and other interested parties.