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

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Musculoskeletal Audit (MSk) - Carpal Tunnel Surgery Altogether 38% of all patients had some patient-centred delay (unavailability; cancelled OPA, review or surgery; did not attend OPA, review or surgery; declined appointment; medically unfit for theatre; Fig. 3). These patients took a median of 35 weeks from referral to surgery, compared to 22 weeks in patients with no documented patient-centred delay. Fig. 3: Percentage of patients with some documented patient-centred delay (see text for definition) 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 As with the arthroscopy report, Fig. 3 shows that a substantial number of patients fail to attend or elect to be “unavailable” at some point in the patient pathway and that unavailability rates continue to vary widely across the country. - - 4
Musculoskeletal Audit (MSk) - Carpal Tunnel Surgery Fig. 4: Average time spent in each stage of the Referral to Treatment process - all patients Mean number of weeks 50 40 30 20 10 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 From referral to OPA Diag/review to theatre list OPA to diagnostics/review Theatre list to surgery NOTES • Times are means for each stage for patients whose data was available • Time from OPA to diagnostics/review is to the first review clinic, or the date the diagnostic (NCS) was performed if the patient was reviewed by phone or letter • Time from diagnostics/review to the date the patient was added to the theatre list is time from first review, and may have included subsequent reviews/diagnostics • If patients were added to the theatre list at the initial OPA, and were not referred for diagnostics or a subsequent review (approximately half of all patients), OPA to diagnostics/review was included as 0 weeks (SO AVERAGE REFLECTS NUMBER WHO HAD NCS AS WELL AS AVERAGE WAIT OF THOSE WHO HAD NCS - SEE LAST BULLET), and diagnostics/review to theatre list as the time between the initial OPA and the date the patient was added to the theatre list. • A small number of patients had diagnostics/reviews after they were apparently added to the theatre list. These were excluded from calculation of time from diagnostics/review to theatre list • The ‘mean’ time for OPA to diagnostics/review includes many patients who were added to the waiting list for surgery at the initial OPA (i.e. time from OPA to diagnostics/review=0 weeks). Therefore the actual distribution of times from OPA to diagnostics/review is not reflected by the mean, and may be skewed by a small number of long waiting times, OR BY A LARGE NUMBER OF PATIENTS WHO WERE NOT SENT FOR NCS. Note that the above figure will not show patient preference delays. For example, some clinics/waiting lists may phone patients to offer a choice of dates for OPA or surgery, and the only data available to the MSk Audit was the date accepted. Note that the time spent waiting from referral to outpatient clinic and on the theatre waiting list is relatively similar between centres. However, there is significantly more variation between centres in time spent waiting for diagnostic investigations (Nerve Conduction Studies), and also the time taken from Diagnostics/Review to being placed on the surgical waiting list. The availability and waiting time for neurophysiology investigations will play a major factor in these differences. The use in some centres of one-stop carpal tunnel clinics with on-site Nerve Conduction Studies will eliminate the wait from OPA to Diagnostics/Review. - - 5
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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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