Carpal Tunnel Report

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Care closer to home

Specialist services in minor surgery, dermatology and ophthalmology provided in a community setting

Cumbria Medical Services

Community Based Carpal Tunnel Service

Service Quality Performance Report

April 2017 – March 2018

Introduction

The service is provided by Dr Martin White, GPwSI in minor surgery, who is mentored and supported by John Harrison, Consultant Orthopaedic Surgeon.  The service is provided from Maryport Community Hospital, London Road Community Clinic, Carlisle, Captain French Surgery and Keswick Hospital.

The service is bookable via Choose and Book after a referral from the patients GP surgery.

Referrals to the service must meet the following evidence based criteria;

  • Symptoms are severe and functional ability reduced
  • Conservative measures such as the use of night splints, physio and injection have failed
  • Positive nerve conduction studies
  • Uncertain diagnosis

The average waiting time from referral to assessment is 4 weeks

Patients are sent a comprehensive patient information leaflet on the procedure and directed to our website for further information.

All patients were assessed and treated within 18 weeks of referral.

Activity

Between April 2017 and March 2018, 487 Patients were seen by the service.

  • 51% Went on to have carpal tunnel decompression under local anaesthetic performed by Dr Martin White.
  • 9% Patients were referred for nerve conduction studies.
  • 66 Minor hand procedures have been carried out from April – March 2018.

 

Following an assessment by Dr White, a further 98 of referred patients did not go on to have a CT release performed.  These patients were treated as follows:

 CT chart 2

Post-Operative Complications

 14 Post-operative infections were reported via the feedback form, which required antibiotics. As we do not see the patients in clinic unless they request a FUP it is unclear whether these patients have had a true infection or whether it has been confused with post-operative swelling and inflammation and given antibiotics unnecessarily.

An audit was carried out on 100 consecutive patients who were asked to return to clinic 3-4 days after their operation to check for any signs of infection. None of these patients were found to have an infection.

Patient Satisfaction

All patients are given the opportunity to feedback on the service with 98 % saying they would recommend the service to their family and friends.

100% of patients are forwarded a patient survey 16 weeks post-op questioning them on a range of subjects including the booking arrangements, scar satisfaction, effectiveness of local anaesthetic, clinic facilities, doctor and nurse manner, and overall satisfaction.

103  Responses to date, with 87 % rating the service excellent, 13 % good and 2 % satisfactory.

Patients are also given the opportunity to feedback on ‘iwantgreatcare’ and via our website www.cumbriamedicalservices.co.uk

Patient comments

April - September 2017

  • Dr White did an exceptional job. His professional manner and expertise being quite remarkable. He deserved 10 out of 10 and a gold star. I am more than happy with the procedure. Many thanks.
  • I am impressed with the whole thing. I was surprised to hear my condition was so advanced but help was close. I felt at ease at the initial appointment and was kept at ease during the procedure by Dr White and the nurse Louise. Everything I needed to do to help me recover was clearly explained. I adhered to the instructions and 8 weeks on had full grip back and the ability to lift quite well. I'm so pleased I was referred to Maryport, lovely hospital (I don't like hospitals much). Thank you so much.
  • My appointments and final treatment were excellent. Dr White explained everything to me, was professional and very easy to communicate with. I found the whole experience a refreshing change; the system worked well for all parties and was a very positive experience. The ease of communication regarding appointments, the locality of clinics I visited (Carlisle and Maryport) and the simple appointment system made it a very positive experience. My hands 12+ weeks on are now pain free. I am able to do tasks I was not able to do before without pain. I would certainly recommend this treatment and clinical team. Thank you.
  • As a working farmer I was grateful for the speed of the service.
  • Everyone was very helpful and went out of their way to look after me as I am in a wheelchair. Thank them very much for me, especially Dr White who even did my surgery on my hand in my wheelchair. Thank you once again.
  • The service and treatment was first class and has given me no hesitation in having my other hand done which is on the 14th July.
  • The doctor and nurses and admin staff were all fantastic.  It was good to be able to have the operation closer to home than having to travel over an hour to Carlisle.  Any questions I had were answered promptly.  I telephoned with a concern after I had my right hand done and was called back within 5 minutes with answers and reassurance that all was well.  My carpal tunnel was very debilitating and although the recovery is quite a long time it has resolved the issues in both hands and was definitely worth having it done.  I have nothing but praise for all concerned in my care and treatment.
  • I could not have had better treatment anywhere. Thank you.

October 2017 - March 2018

  • The whole procedure was carried out professionally and all in all not a bad experience. Thank you to Dr White and his team.
  • Have now had both hands operated on - the left one is very successful and I now have no symptoms. The right one was done recently and I still have symptoms, i.e. pins and needles. I rang the clinic and they said they would ask Dr White to ring me back; he did and suggested that it was early days and it would improve. I was grateful for his comments but the symptoms are still there. I do understand that the operation is not always successful!
  • I was surprised at the prompt and efficient service; the assessment to the operation was less than a month. Parking at the clinic was simple and free and waiting time to see the consultant was negligible. As I was warned that the injection of the anaesthetic would sting that was no problem. The aftercare was made clear to me by one of the nurses who assisted.
  • I would honestly recommend this treatment to anyone needing it! My brother is now on the waiting list! The clinic at Maryport Hospital where I had the procedure was brilliant - I was actually out of the clinic in about 20/25 mins. Couldn't believe how quick it was. Dr Martin White and his assistant Amanda were very kind and professional. After, I think it was 2 days and I had to remove the first dressing I couldn't manage to, I had to go to the nurse in my practice. She dressed it and I actually went twice more for dressings as she told me it had infected! I think it was unfortunate but these things happen - I would certainly have my other hand done if needed - I was impressed with the whole procedure!
  • I have had two minor procedures carried out by Dr White and both have been very successful. Although I was given antibiotics for a suspected minor infection the wound has healed well and Dr White was most helpful with support by telephone and also gave me an appointment at short notice to double check the wrist/hand.
  • Wonderful, the doctors and staff were absolutely brilliant.
  • I am extremely grateful for the two carpal tunnel operations given by the medical team. Wooden and useless hands are functioning again. Such joy to have live finger ends: to hold and grasp. Permanent care was becoming a reality with me already having a hired day care in twice a week. An office administration error resulted in an extra two months of agony. The ongoing service was confusing with me receiving contradictory advice in the early stages of assessment. I cannot heap enough praise on the medical team who have given me my independence back.
  • Dr White and his team couldn't have been nicer. Would have had this procedure done sooner had I been aware of the carpal tunnel service. Really no need for hospital stay - waste of time, money and resources. Scar is healing nicely and hand function back to normal. Only slight discomfort when using garden shears - but this is only to be expected. Thanks to Dr White and his team.

For more information on this report or the carpal tunnel service please contact Pauline Stuart at paulinestuart@nhs.net