College of Medicine, University of Malawi, Mahatma Ghandi Road, Blantyre, Malawi.
Epidemiology and Public Health Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland.
World J Surg. 2021 Feb;45(2):356-361. doi: 10.1007/s00268-020-05809-3. Epub 2020 Oct 7.
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.
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.
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.
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.
由于专业外科医生短缺，尤其是在农村地区，像马拉维这样的低收入国家获取外科手术服务面临挑战。地区医院（DH）满足农村患者的紧急外科需求，将复杂病例转至中心医院（CH），通常没有事先沟通。
2018 年，建立了一个安全的外科管理咨询网络（MCN），以改善伊丽莎白女王医院和宗巴中央医院的外科专家和麻醉师与转诊至这些机构的九家 DH 的外科医生之间的沟通。
2018 年 5 月至 12 月，DH 通过 MCN 就 249 例外科病例请求专家意见，包括匿名图像（52%的病例）。96%的病例收到了意见，中位数有两位专家回答。74%的病例在一小时内收到了第一份回复，68%的病例在将病例发布到 MCN 后一个小时内做出了决定。60%的病例建议立即转诊，26%的病例不建议转诊，11%的病例建议以后可能转诊。
MCN 便于在偏远农村地区快速获得如何管理外科患者的专家咨询。它还有助于避免不必要的转诊，为患者、其监护人、转诊医院和整个卫生系统节省费用。随着时间的推移，该网络产生了溢出效应，使卫生部能够更密切地监测地区的外科活动，并更快地应对基本外科资源短缺的问题。
