Referral-to-Treatment for Surgical Carpal Tunnel ... - 18 Weeks

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Musculoskeletal Audit (MSk) - Carpal Tunnel Surgery D) Diagnostics The mean length of time from when Nerve Conduction Studies were ordered to when they were carried out was 16 weeks, but this varied greatly across hospitals (0-63 weeks). The distribution of waiting times for NCS is shown in Fig. 11. Fig. 11: Time from date of NCS request to NCS performed Percentage of patients 100 80 60 40 20 0 Wishaw GRI/Stobhill DGRI/Garrick QMH/Victoria Elgin Borders Ninewells/Stra RAH/VOL ARI/Woodend Perth Monklands Hairmyres St Johns/RIE Raigmore IRH/Dunoon Forth Valley All patients 0-8 weeks 8-16 weeks 16-25 weeks 25-50 weeks >50 weeks Missing data Within any particular hospital, Nerve Conduction Studies tended to be done either inhouse or offsite. GRI, QMH, Ninewells, ARI and Raigmore carried out NCS inhouse. All other hospitals carried out NCS mainly offsite. Neurophysiologists carried out the majority of NCS for many units (Fig. 12). Fig. 12: Grade of staff who carried out NCS Percentage of patients 100 80 60 40 20 0 Wishaw GRI/Stobhill DGRI/Garrick QMH/Victoria Elgin Borders Ninewells/Stra RAH/VOL ARI/Woodend Perth Monklands Hairmyres St Johns/RIE Raigmore IRH/Dunoon Forth Valley All patients Neurophysiologist Technician Other medical staff Missing data In most units, patients who had their NCS carried out by technicians had them done more quickly than those carried out by neurophysiologists. However a neurophysiologist will still need to issue the final report, which may result in further delay. - - 12
Musculoskeletal Audit (MSk) - Carpal Tunnel Surgery Once Nerve Conduction Studies were ordered, there were significant differences in subsequent waiting time between the units conducting NCS (Fig. 13). Fig. 13: Time to NCS by hospital and NCS unit Time to NCS (weeks) 80 60 40 20 0 Each triangle colour represents a different unit that carries out Wishaw RAH/VOL Monklands Hairmyres IRH/Dunoon Elgin ARI/Woodend Raigmore Ninewells/Stra Perth DGRI/Garrick Borders St Johns/RIE Forth Valley GRI/Stobhill QMH/Victoria Triangles are the mean time from when NCS were ordered to when they were carried out. Upper and lower lines show range of time during which 25-75% of NCS were carried out (so 25% were done before the minimum point of the line and 25% were done after the upper point of the line). Each different coloured triangle represents a different NCS unit (i.e. all hospitals with the same colour of triangle had NCS done at the same unit). It appears that in units where Nerve Conduction Studies are carried out by a neurophysiology service covering several hospitals that there are longer waiting times. This would suggest that in these areas the neurophysiology service is not currently sufficient to cover the work load. Is one way of easing this problem by increasing the amount of technicians available to assist the neurophysiologists and a more robust referral and triaging system in place to determine which grade of staff is required to carry out the NCS Although local Nerve Conduction practises appear to hide any relationship between the average length of wait for Nerve Conduction Studies and the proportion of each centre’s patients that have NCS, long delays may deter consultants from ordering NCS. In some centres Nerve Conduction Studies may be used more often if they were more readily available. - - 13
Page 1 and 2: Referral-to-Treatment for Surgical
Page 3 and 4: A) Summary of overall period from R
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Page 9 and 10: C) Time from Outpatient Appointment
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Referral-to-Treatment for Surgical Carpal Tunnel ... - 18 Weeks

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