Overnight shift handover in district hospital emergency departments creates a structural boundary at which trauma triage acuity is reclassified, and this reclassification may systematically reduce the detection of post-traumatic stress disorder (PTSD) among injured patients. The analysis draws on 154 country-survey observations from 38 African countries over the period 1986 to 2025, with a mean indicator value of 27.756 and a standard deviation of 9.876. The framework specifies how triage acuity reclassification at handover generates differential PTSD detection probabilities across shift boundaries, and how difference-in-differences identification can separate this boundary effect from secular trends in screening uptake. The contribution is a methodological specification for shift-boundary effects in trauma mental health screening, with implications for triage protocol design and handover documentation in Ethiopian referral clinics.
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Wolde et al. (2026) studied this question.
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