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Feasibility and validity of telephone triage for adverse events during a voluntary medical male circumcision campaign in Swaziland.

Ashengo TA, Grund J, Mhlanga M, Hlophe T, Mirira M, Bock N, Njeuhmeli E, Curran K, Mallas E, Fitzgerald L, Shoshore R, Moyo K, Bicego G - BMC Public Health (2014)

Bottom Line: Voluntary medical male circumcision (VMMC) reduces HIV acquisition among heterosexual men by approximately 60%.Both datasets were de-identified and did not contain any personal identifiers.Eighty-nine (26%) of the 341 clients who were diagnosed with AEs by clinicians at a VMMC site had initially called the VMMC hotline.

View Article: PubMed Central - PubMed

Affiliation: Maternal and Child Health Integrated Program (MCHIP), and Jhpiego-an affiliate of the Johns Hopkins University, Washington, DC, USA. tadamu@jhpiego.net.

ABSTRACT

Background: Voluntary medical male circumcision (VMMC) reduces HIV acquisition among heterosexual men by approximately 60%. VMMC is a surgical procedure and some adverse events (AEs) are expected. Swaziland's Ministry of Health established a toll-free hotline to provide general information about VMMC and to manage post-operative clinical AEs through telephone triage.

Methods: We retrospectively analyzed a dataset of telephone calls logged by the VMMC hotline during a VMMC campaign. The objectives were to determine reasons clients called the VMMC hotline and to ascertain the accuracy of telephone-based triage for VMMC AEs. We then analyzed VMMC service delivery data that included date of surgery, AE type and severity, as diagnosed by a VMMC clinician as part of routine post-operative follow-up. Both datasets were de-identified and did not contain any personal identifiers. Proportions of AEs were calculated from the call data and from VMMC service delivery data recorded by health facilities. Sensitivity analyses were performed to assess the accuracy of phone-based triage compared to clinically confirmed AEs.

Results: A total of 17,059 calls were registered by the triage nurses from April to December 2011. Calls requesting VMMC education and counseling totaled 12,492 (73.2%) and were most common. Triage nurses diagnosed 384 clients with 420 (2.5%) AEs. According to the predefined clinical algorithms, all moderate and severe AEs (153) diagnosed through telephone-triage were referred for clinical management at a health facility. Clinicians at the VMMC sites diagnosed 341 (4.1%) total clients as having a mild (46.0%), moderate (47.8%), or severe (6.2%) AE. Eighty-nine (26%) of the 341 clients who were diagnosed with AEs by clinicians at a VMMC site had initially called the VMMC hotline. The telephone-based triage system had a sensitivity of 69%, a positive predictive value of 83%, and a negative predictive value of 48% for screening moderate or severe AEs of all the AEs.

Conclusions: The use of a telephone-based triage system may be an appropriate first step to identify life-threatening and urgent complications following VMMC surgery.

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Related in: MedlinePlus

Adverse event notification and management network.
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Fig1: Adverse event notification and management network.

Mentions: The nurses who provided telephone triage for VMMC completed a full course of competency-based clinical training on male circumcision under local anesthesia, which is the same training required of surgical nurses in VMMC facilities. Triage nurses were trained to assess VMMC clients’ concerns without the advantage of visual inspection or face-to-face interaction, by using comprehensive algorithms of AEs developed by a team of experienced VMMC-provider clinicians in Swaziland. They were required to rely on their communication skills and knowledge of the VMMC procedure, routine post-operative healing stages, and common post-operative AEs in order to accurately ascertain the client’s condition and needs. The function of the telephone triage nurse was to determine whether the caller had a VMMC-related complaint or sought information about VMMC. For those seeking information, the triage nurses provided general VMMC-related information and education VMMC service delivery in Swaziland. For those calling with suspected AEs, the triage nurses would use a series of algorithms to determine the cause and severity of the complaint. The triage nurse would then direct the caller to the appropriate emergency services, if necessary, and/or recommend medical follow-up based on established triage protocols (Figure 1). During the Soka Uncobe campaign, the EPR was staffed with five trained nurses who provided 24-hour coverage on a rotating basis.Figure 1


Feasibility and validity of telephone triage for adverse events during a voluntary medical male circumcision campaign in Swaziland.

Ashengo TA, Grund J, Mhlanga M, Hlophe T, Mirira M, Bock N, Njeuhmeli E, Curran K, Mallas E, Fitzgerald L, Shoshore R, Moyo K, Bicego G - BMC Public Health (2014)

Adverse event notification and management network.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4150954&req=5

Fig1: Adverse event notification and management network.
Mentions: The nurses who provided telephone triage for VMMC completed a full course of competency-based clinical training on male circumcision under local anesthesia, which is the same training required of surgical nurses in VMMC facilities. Triage nurses were trained to assess VMMC clients’ concerns without the advantage of visual inspection or face-to-face interaction, by using comprehensive algorithms of AEs developed by a team of experienced VMMC-provider clinicians in Swaziland. They were required to rely on their communication skills and knowledge of the VMMC procedure, routine post-operative healing stages, and common post-operative AEs in order to accurately ascertain the client’s condition and needs. The function of the telephone triage nurse was to determine whether the caller had a VMMC-related complaint or sought information about VMMC. For those seeking information, the triage nurses provided general VMMC-related information and education VMMC service delivery in Swaziland. For those calling with suspected AEs, the triage nurses would use a series of algorithms to determine the cause and severity of the complaint. The triage nurse would then direct the caller to the appropriate emergency services, if necessary, and/or recommend medical follow-up based on established triage protocols (Figure 1). During the Soka Uncobe campaign, the EPR was staffed with five trained nurses who provided 24-hour coverage on a rotating basis.Figure 1

Bottom Line: Voluntary medical male circumcision (VMMC) reduces HIV acquisition among heterosexual men by approximately 60%.Both datasets were de-identified and did not contain any personal identifiers.Eighty-nine (26%) of the 341 clients who were diagnosed with AEs by clinicians at a VMMC site had initially called the VMMC hotline.

View Article: PubMed Central - PubMed

Affiliation: Maternal and Child Health Integrated Program (MCHIP), and Jhpiego-an affiliate of the Johns Hopkins University, Washington, DC, USA. tadamu@jhpiego.net.

ABSTRACT

Background: Voluntary medical male circumcision (VMMC) reduces HIV acquisition among heterosexual men by approximately 60%. VMMC is a surgical procedure and some adverse events (AEs) are expected. Swaziland's Ministry of Health established a toll-free hotline to provide general information about VMMC and to manage post-operative clinical AEs through telephone triage.

Methods: We retrospectively analyzed a dataset of telephone calls logged by the VMMC hotline during a VMMC campaign. The objectives were to determine reasons clients called the VMMC hotline and to ascertain the accuracy of telephone-based triage for VMMC AEs. We then analyzed VMMC service delivery data that included date of surgery, AE type and severity, as diagnosed by a VMMC clinician as part of routine post-operative follow-up. Both datasets were de-identified and did not contain any personal identifiers. Proportions of AEs were calculated from the call data and from VMMC service delivery data recorded by health facilities. Sensitivity analyses were performed to assess the accuracy of phone-based triage compared to clinically confirmed AEs.

Results: A total of 17,059 calls were registered by the triage nurses from April to December 2011. Calls requesting VMMC education and counseling totaled 12,492 (73.2%) and were most common. Triage nurses diagnosed 384 clients with 420 (2.5%) AEs. According to the predefined clinical algorithms, all moderate and severe AEs (153) diagnosed through telephone-triage were referred for clinical management at a health facility. Clinicians at the VMMC sites diagnosed 341 (4.1%) total clients as having a mild (46.0%), moderate (47.8%), or severe (6.2%) AE. Eighty-nine (26%) of the 341 clients who were diagnosed with AEs by clinicians at a VMMC site had initially called the VMMC hotline. The telephone-based triage system had a sensitivity of 69%, a positive predictive value of 83%, and a negative predictive value of 48% for screening moderate or severe AEs of all the AEs.

Conclusions: The use of a telephone-based triage system may be an appropriate first step to identify life-threatening and urgent complications following VMMC surgery.

Show MeSH
Related in: MedlinePlus