Evaluation of a managed surgical consultation network in Malawi

Background Access to surgery is a challenge for low-income countries like Malawi due to shortages of specialists, especially in rural areas. District hospitals (DH) cater for the immediate surgical needs of rural patients, sending difficult cases to central hospitals (CH), usually with no prior comm...

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Main Authors: Mwapasa, G, Pittalis, C, Clarke, M, Bijlmakers, L, Le, G, Mkandawire, N, Brugha, R, Borgstein, E, Gajewski, J
Format: Journal article
Language:English
Published: Springer 2020
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author Mwapasa, G
Pittalis, C
Clarke, M
Bijlmakers, L
Le, G
Mkandawire, N
Brugha, R
Borgstein, E
Gajewski, J
author_facet Mwapasa, G
Pittalis, C
Clarke, M
Bijlmakers, L
Le, G
Mkandawire, N
Brugha, R
Borgstein, E
Gajewski, J
author_sort Mwapasa, G
collection OXFORD
description Background Access to surgery is a challenge for low-income countries like Malawi due to shortages of specialists, especially in rural areas. District hospitals (DH) cater for the immediate surgical needs of rural patients, sending difficult cases to central hospitals (CH), usually with no prior communication. Methods In 2018, a secure surgical managed consultation network (MCN) was established to improve communication between specialist surgeons and anaesthetists at Queen Elizabeth and Zomba Central Hospitals, and surgical providers from nine DHs referring to these facilities. Results From May to December 2018, DHs requested specialist advice on 249 surgical cases through the MCN, including anonymised images (52% of cases). Ninety six percent of cases received advice, with a median of two specialists answering. For 74% of cases, a first response was received within an hour, and in 68% of the cases, a decision was taken within an hour from posting the case on MCN. In 60% of the cases, the advice was to refer immediately, in 26% not to refer and 11% to possibly refer at a later stage. Conclusion The MCN facilitated quick access to consultations with specialists on how to manage surgical patients in remote rural areas. It also helped to prevent unnecessary referrals, saving costs for patients, their guardians, referring hospitals and the health system as a whole. With time, the network has had spillover benefits, allowing the Ministry of Health closer monitoring of surgical activities in the districts and to respond faster to shortages of essential surgical resources.
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spelling oxford-uuid:3fcd3825-0141-41c7-8871-006947f951fc2022-03-26T14:34:16ZEvaluation of a managed surgical consultation network in MalawiJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:3fcd3825-0141-41c7-8871-006947f951fcEnglishSymplectic ElementsSpringer2020Mwapasa, GPittalis, CClarke, MBijlmakers, LLe, GMkandawire, NBrugha, RBorgstein, EGajewski, JBackground Access to surgery is a challenge for low-income countries like Malawi due to shortages of specialists, especially in rural areas. District hospitals (DH) cater for the immediate surgical needs of rural patients, sending difficult cases to central hospitals (CH), usually with no prior communication. Methods In 2018, a secure surgical managed consultation network (MCN) was established to improve communication between specialist surgeons and anaesthetists at Queen Elizabeth and Zomba Central Hospitals, and surgical providers from nine DHs referring to these facilities. Results From May to December 2018, DHs requested specialist advice on 249 surgical cases through the MCN, including anonymised images (52% of cases). Ninety six percent of cases received advice, with a median of two specialists answering. For 74% of cases, a first response was received within an hour, and in 68% of the cases, a decision was taken within an hour from posting the case on MCN. In 60% of the cases, the advice was to refer immediately, in 26% not to refer and 11% to possibly refer at a later stage. Conclusion The MCN facilitated quick access to consultations with specialists on how to manage surgical patients in remote rural areas. It also helped to prevent unnecessary referrals, saving costs for patients, their guardians, referring hospitals and the health system as a whole. With time, the network has had spillover benefits, allowing the Ministry of Health closer monitoring of surgical activities in the districts and to respond faster to shortages of essential surgical resources.
spellingShingle Mwapasa, G
Pittalis, C
Clarke, M
Bijlmakers, L
Le, G
Mkandawire, N
Brugha, R
Borgstein, E
Gajewski, J
Evaluation of a managed surgical consultation network in Malawi
title Evaluation of a managed surgical consultation network in Malawi
title_full Evaluation of a managed surgical consultation network in Malawi
title_fullStr Evaluation of a managed surgical consultation network in Malawi
title_full_unstemmed Evaluation of a managed surgical consultation network in Malawi
title_short Evaluation of a managed surgical consultation network in Malawi
title_sort evaluation of a managed surgical consultation network in malawi
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