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

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Musculoskeletal Audit (MSk) - Carpal Tunnel Surgery B) Referral to Outpatient Appointment 92% of 1021 patients with documented length of time from Referral to Outpatient Appointment were seen within 15 weeks (Fig. 5). However, a large proportion of patients waited for 10 to 15 weeks before their Outpatient Appointment, leaving little time in the proposed 18 week pathway for investigations and/or treatment to occur. Fig. 5: Length of time from Referral to Outpatient Appointment 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 15 weeks Missing data Fig. 5 includes all patients irrespective of any reason for delay, and reflects the 15-week target for referral to Outpatient Appointment in operation at the start of the audit period. Comparison against the 12-week target times which came into place in March 2010 are available on request Although it was usually possible to find out who vetted patients and the vetting outcome, in many hospitals first vetting date was often unavailable (Table 2). This may improve with the introduction of e-vetting in some sites, and recording of vetting dates by whichever method has increased from 42% during the arthroscopy audit to 61% during the CTS audit period. Amongst patients whose vetting times were known, 91% of patients were vetted within a week (Table 2). Table 2: Average time from Referral to First Vetting % of patients whose vetting dates was documented Number of patients documented Referral to vetting Mean (weeks) % > 1 week Wishaw 0% 0 - - GRI/Stobhill 92% 60 0.0 0% DGRI/Garrick 100% 64 0.0 0% QMH/Victoria 65% 51 1.4 53% Elgin 21% 5 0.0 0% Borders 96% 55 0.0 0% Ninewells/Stracathro 28% 22 0.4 5% RAH/VOL 28% 20 1.2 50% ARI/Woodend 7% 4 * * Perth 89% 17 0.2 0% Monklands 78% 31 0.9 19% Hairmyres 21% 19 0.8 16% St Johns/RIE 96% 146 0.1 1% Raigmore 89% 55 0.1 0% Inverclyde/Dunoon 66% 31 0.6 0% Forth Valley 37% 20 0.7 15% All patients 61% 600 0.3 9% * Data omitted if based on fewer than 5 patients - - 6
Musculoskeletal Audit (MSk) - Carpal Tunnel Surgery Hospital vetting policies vary considerably (Fig. 6). Fig. 6 also highlights the ongoing problem of poor documentation of the vetting process in some sites. If known, almost all patients originally vetted by clerical staff were subsequently vetted by medical staff. The overall time from referral to surgery was shorter if patients were first vetted by medical staff compared to ESPs or clerical staff (median 21 weeks compared to 29 or 33 weeks). When known, 83% of patients who were vetted twice were second-vetted within a week. Fig. 6: Who first vetted patients post Referral 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 Percentage of patients Medical staff ESP Clerical staff Not vetted Missing data 53% of patients who were not vetted were unscheduled referrals (e.g. from ED). Others included patients going on to have Carpal Tunnel surgery following referrals or reviews for other procedures. As expected, much of the time elapsed between Referral and Outpatient Appointment occurred whilst the patient awaited their offered OPA date. The average wait from the date the OPA was ready for allocation to the date offered for OPA was 7.8 weeks, but many hospitals had a considerable proportion of patients who waited more than eight weeks (Table 3). Table 3: Average times from Vetting to Outpatient Appointment Vetting to Ready for Allocation N Mean (weeks ) % > 8 week s N Allocation to Date Offered Mean (weeks) % > 8 weeks Date Offered to OPA attendance N Mean (weeks ) % > 8 week s Wishaw 0 - - 26 10.9 92% 27 0.0 0% GRI/Stobhill 59 0.3 0% 65 10.8 75% 66 1.7 5% DGRI/Garrick 64 0.6 0% 65 7.3 51% 65 0.1 0% QMH/Victoria 50 5.1 10% 78 3.9 5% 79 0.3 0% Elgin 6 0.0 0% 25 7.6 36% 26 0.5 4% Borders 55 0.0 0% 59 8.9 61% 62 0.9 3% Ninewells/Stracathro 22 2.3 5% 76 4.0 3% 84 0.4 1% RAH/VOL 20 0.4 0% 75 7.2 48% 80 0.5 0% ARI/Woodend 2 * * 43 6.0 9% 66 0.4 2% Perth 17 0.3 0% 17 10.9 76% 18 0.6 0% Monklands 31 0.0 0% 42 10.5 86% 42 0.7 2% Hairmyres 19 0.0 0% 99 10.1 82% 100 0.5 4% St Johns/RIE 144 2.3 5% 145 8.8 77% 148 0.6 3% Raigmore 56 0.1 0% 60 9.1 65% 61 0.4 0% Inverclyde/Dunoon 31 3.6 3% 42 4.2 2% 46 0.8 2% Forth Valley 20 0.0 0% 44 7.4 39% 54 0.1 0% All patients 596 1.4 2% 961 7.8 51% 1024 0.6 2% * Data omitted if based on fewer than 5 patients; sample sizes vary between columns due to availability of data - - 7
Page 1 and 2: Referral-to-Treatment for Surgical
Page 3 and 4: A) Summary of overall period from R
Page 5: Musculoskeletal Audit (MSk) - Carpa
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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