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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

Triage algorithm #1: Voiding difficulties: Nurse algorithm: Post-operative voiding difficulties (Inability to Pass Urine).
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Fig2: Triage algorithm #1: Voiding difficulties: Nurse algorithm: Post-operative voiding difficulties (Inability to Pass Urine).

Mentions: Treatment algorithms were created for four common AEs that have the potential to become severe: bleeding, voiding difficulty, pain, and infection. Triage nurses utilized the algorithms to guide their telephone-based clinical decision-making (Figures 2,3 and4). Nurses assessed a caller’s symptoms first by determining the most acute and urgent conditions in order to determine the need for emergency intervention. Depending on the caller’s responses, the nurses followed specific procedures to obtain the necessary information and determine a course of action, as per the clinical recommendations[11]. As soon as triage nurses ruled out the possibility of critical or life-threatening AEs, they determined the type and severity of the complaint. If a nurse determined the complaint to be less serious than a mild AE, the nurse provided reassurance and information on wound care. If a nurse determined that a caller was experiencing a moderate or severe AE, he/she directed the caller to the nearest health facility for treatment. If the caller needed emergency transport to the clinic, then the nurse arranged for a vehicle to be sent to the caller’s location, free of charge. The nurse also informed the receiving site of the client’s condition and pending arrival (Figure 5).Figure 2


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)

Triage algorithm #1: Voiding difficulties: Nurse algorithm: Post-operative voiding difficulties (Inability to Pass Urine).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Fig2: Triage algorithm #1: Voiding difficulties: Nurse algorithm: Post-operative voiding difficulties (Inability to Pass Urine).
Mentions: Treatment algorithms were created for four common AEs that have the potential to become severe: bleeding, voiding difficulty, pain, and infection. Triage nurses utilized the algorithms to guide their telephone-based clinical decision-making (Figures 2,3 and4). Nurses assessed a caller’s symptoms first by determining the most acute and urgent conditions in order to determine the need for emergency intervention. Depending on the caller’s responses, the nurses followed specific procedures to obtain the necessary information and determine a course of action, as per the clinical recommendations[11]. As soon as triage nurses ruled out the possibility of critical or life-threatening AEs, they determined the type and severity of the complaint. If a nurse determined the complaint to be less serious than a mild AE, the nurse provided reassurance and information on wound care. If a nurse determined that a caller was experiencing a moderate or severe AE, he/she directed the caller to the nearest health facility for treatment. If the caller needed emergency transport to the clinic, then the nurse arranged for a vehicle to be sent to the caller’s location, free of charge. The nurse also informed the receiving site of the client’s condition and pending arrival (Figure 5).Figure 2

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