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

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Musculoskeletal Audit (MSk) - Carpal Tunnel Surgery Nine per cent of OPAs were delayed because patients either Did Not Attend, cancelled or were otherwise unavailable (Fig. 7). A further 2% were delayed because the hospital cancelled the appointments. Fig. 7: First reason for delay to OPA Percentage of patients 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 No delay Unknown reason Patient unavailable (includes 'declined appt') Clinic cancelled original appointment Patient cancelled original appointment Did Not Attend Excludes 17 patients whose offer date for OPA was unknown, or who were referred directly for diagnostics or surgery without a conventional OPA (e.g. after review for a different condition, or from private clinics for NHS treatment, etc) Borders General Hospital had higher than usual cancelled clinics in the audit period due to temporary staffing difficulties - - 8
C) Time from Outpatient Appointment to Diagnostics/Review Musculoskeletal Audit (MSk) - Carpal Tunnel Surgery Carpal tunnel patients were managed in a number of different ways following their initial Outpatient Appointment (Fig. 8). 50% were added to the waiting list for surgery without further diagnostic tests or further review. 39% were sent for Nerve Conduction Studies (only rarely for other diagnostic tests), and were then either reviewed by further OPA or by phone/letter. Most of the remaining 11% were referred for continuing management, treatment or to other clinicians, and were reviewed by further OPA prior to surgery (Fig. 8). Fig. 8: Path from Outpatient Appointment to Surgery 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 Added to surgical waiting list at OPA NCS - reviewed by phone/letter Other NCS - reviewed by further OPA No NCS, but further review OPA ‘Other’ encompasses a number of patients with unusual paths to surgery, including some private patients, those who left their OPA to consider options before getting back in touch, reviewed by letter without an OPA, or sent for diagnostics but cancelled and added straight to list Fig. 8 highlights the considerable variation in use of Nerve Conduction Studies between centres. In some centres, the vast majority of carpal tunnel decompressions are performed without Nerve Conduction Studies. It remains controversial as to which patients should have pre-operative Nerve Conduction Studies. In the UK it is generally accepted that not all patients with carpal tunnel syndrome necessarily need pre-operative Nerve Conduction Studies. However, the consensus in the hand surgery community is that Nerve Conduction Studies are an important diagnostic tool and should be available for the assessment of patients with carpal tunnel syndrome. - - 9
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Referral-to-Treatment for Surgical Carpal Tunnel ... - 18 Weeks

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