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

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Musculoskeletal Audit (MSk) - Carpal Tunnel Surgery How to use this report The Referral to Treatment period of surgical CTS patients is summarised on an individual hospital basis, firstly (A) for the whole period from Referral to Treatment, then in more detail for the constituent parts of this process: B Referral to Outpatient Appointment (OPA) C OPA to Diagnostics/Review D Diagnostics E Surgery Note that not all patients followed a conventional path from referral to outpatient appointment, subsequent diagnostics and review to surgery (e.g. patients could be referred into the system to an NHS hospital from a private clinic). Also, some dates for various parts of the patient journey (particularly vetting and allocation dates) were not always available. This explains variation in sample sizes across the report. The 18-week Referral to Treatment target does, of course, allow for clock-stopping for circumstances beyond a hospital’s control. Allowing for all such patient-centred delays was beyond the remit of this audit, although some summary data are included. Inspection of the constituent parts of the patient referral-tosurgery period should reveal the main limiting steps in each unit, but, if it would be useful, please ask us to select or break down your information further. During the audit period the Local Audit Co-ordinators achieved a near 100% inclusion rate of carpal tunnel release patients in most participating hospitals (Table 1). Almost all Carpal Tunnel surgery was carried out by the Orthopaedic specialty, except in StJohns/RIE (98% by Plastics) and ARI/Woodend (24% by Neurology/Neurosurgery). Table 1: Number of patients reported on Hospital Audit period * Number of surgical CTS patients identified in report period in each hospital Number of surgical CTS patients included in this report* Wishaw Oct 2009-Apr 2010 32 32 GRI / Stobhill Oct 2009-Apr 2010 80 80 DGRI / Garrick Oct 2009-Apr 2010 67 67 QMH / Victoria Jan 2010-Apr 2010 101 101 Elgin Nov 2009-Apr 2010 32 32 Borders Oct 2009-Apr 2010 69 69 Ninewells / Stracathro ** Jan 2010-Apr 2010 94 94 RAH/VOL Nov 2009-Apr 2010 91 91 ARI / Woodend Jan 2010-Apr 2010 91 90 Perth Jan 2010-Apr 2010 25 25 Monklands *** Oct 2009-Apr 2010 54 54 Hairmyres Oct 2009-Apr 2010 107 107 St Johns / RIE Jan 2010-Apr 2010 187 178 Raigmore Oct 2009-Apr 2010 73 71 Inverclyde / Dunoon Oct 2009-Apr 2010 59 59 Forth Valley Oct 2009-Apr 2010 68 68 Total 1230 1218 * End of Audit period was 9th April 2010 for all hospitals ** Includes 9 patients originating at Ninewells who were operated on at PRI *** Includes 5 patients originating at Monklands who were operated on at Hairmyres Patients sent to Golden Jubilee National Hospital for surgery between October and 9th April (57 altogether, including 43 from Lothian HB and 9 from Dumfries and Galloway) are not included in Table 1 or in other sections of this report. Data from Ayrshire and Arran was less complete than for other hospitals and is not included in this report - - 2
A) Summary of overall period from Referral to Treatment Musculoskeletal Audit (MSk) - Carpal Tunnel Surgery Although many patients are referred or diagnosed with bilateral carpal tunnel syndrome, the patient pathway (and consequently the length of time from referral to treatment) varies significantly between treatment for first and second procedures. Due to these differences, all data contained in parts A-E of this report pertain to the hand treated first, unless there was a considerable time gap before the second hand necessitating a completely independent diagnosis and treatment cycle. Second/subsequent procedures that followed on immediately after treatment of the first hand (15% of all carpal tunnel operations) are detailed separately in part F. Fig. 1: Length of time from referral to surgery - all patients 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 1 year Missing data Missing data occurred if referral date was not known, often from an unconventional source (e.g. referral from a review of another treatment, or straight to Nerve Conduction Studies or a private patient listed for surgery) Fig. 1 includes 273 (26%) patients who had indicated that they were unavailable at some stage between referral and surgery. If unavailable at some stage, documented unavailability averaged 45 days (median=32 days), and 100 (10%) patients were known to be unavailable for more than six weeks. Only 11% of patients who had indicated that they were unavailable at some stage between referral and surgery were treated within 18 weeks, compared to 28% of patients who were available throughout. Fig. 2 reports the percentage of patients who met the 18-week Referral to Treatment target after excluding these unavailable patients. Fig. 2: Length of time from referral to surgery - excluding patients who were unavailable at some stage during this period 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 1 year Missing data - - 3
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Page 9 and 10: C) Time from Outpatient Appointment

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

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