Carpal Tunnel Report

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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 2018 – March 2019

Introduction

Our community based Carpal Tunnel Service is delivered by Dr Martin White, GPER 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 and Keswick Hospital.

Patients are referred to the service by the MSK team.

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

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

Waiting times

The average waiting time from referral to assessment is 4 weeks. All patients in this reporting period were assessed and treated within 18 weeks of referral.

Activity

260 patients were seen by the service between April and March 2019. Of these, 85% went on to have carpal tunnel decompression performed by Dr Martin White.  55 patients had a bilateral procedure.

Following an assessment by Dr White, a further 15% of referred patients did not go on to have a CT release performed. 

54 patients were treated by injection.

30 patients were discharged as asymptomatic.

19 patients were referred for nerve conduction studies

3 patients were referred onto secondary care for further assessment

Post-Operative Complications  

12 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.

A previous audit carried out post operatively in clinic on 100 consecutive patients showed no infections.

Patient Satisfaction

100% of patients are forwarded a patient survey 12 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.

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

94 questionnaires have been returned to date with 86% rating the service excellent and 14% good.

CT chart 2

Patient comments included

  • I would suggest getting both hands done at the same time should be discouraged. I did it at my request without really understanding how debilitating the restrictions in use of both hands would be at the early stages of recovery (first few days).
  • Both hands were done very fast, no more pain. Service very good.
  • I was extremely pleased from the moment I walked in the door until leaving. The care from all involved was excellent. Thank you.
  • Excellent, a great team. Had my other hand done January 2018. This operation was more uncomfortable that the first (Dr White said it was tighter than the other hand. He is excellent).
  • Excellent service and result.
  • Both hands were done very fast, no more pain. Service very good.
  • I am very impressed with all aspects of the service. I was conscious throughout both procedures and enjoyed talking to the professionals that took very good care of me.
  • Very happy with the quick and efficient service and appointments system.
  • The nurses and doctor put me completely at my ease and I felt comfortable throughout.
  • Absolutely excellent service from start to finish. Highly professional and caring team with excellent communication skills.