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Referral quality at the one-stop Carpal
Tunnel clinic: does it influence
conversion rates?
Henry Brice, Paul Stirling, Karen Au-Yeung, Joanne
Finnigan, David Ellis
Manchester Royal Infirmary (MRI), Manchester,
England
Benefits of a one-stop Carpal Tunnel Clinic
• Integrates primary and secondary care, reducing waiting times to surgery
• 37,745 Carpal Tunnel Decompressions in UK in 20011
• UK NHS 18-week Patient Pathway from referral to treatment
• Currently up to 9 month delays for surgery2
• Longer waiting times for surgery = increased working days lost3
• MRI one-stop clinic:
- orthopaedic examination
- nerve conduction studies
Aims
1. To investigate quality of referrals to the one stop clinic from Primary Care
Physicians
1. To determine how referral quality affects clinic efficiency
2. To identify means of improving the referral process
Methods
• Retrospective screening of Primary Care referrals
• Exclusion criteria: age>75, ulnar sensory symptoms, Diabetes Mellitus,
previous wrist fracture, Rheumatoid Arthritis and hand muscle wasting.
• Adequate referrals: detailed sensory symptoms and mentioned specific
exclusion criteria.
• Surgical “hit-rate” used as outcome measure: adequate and inadequate
referrals compared
• Hypothesis: poorer quality referral letter reduces surgical “hit-rate”
Results
• 18/58 adequate referrals (31%)
•
9 patients opted for conservative management
Discussion
• Surgical ‘hit rate’ lower than published in literature (70%)4
• Rises to 64% if conservative management included
• Higher ‘hit rate’ in adequate referrals group
• Specific Primary Care referral proforma to improve ‘hit rate’
• Includes exclusion criteria
• Details of symptoms
• Patients for surgical treatment
Summary: Primary and Secondary care roles
• Proforma to improve referral quality and clinic surgical ‘hit rates’
• Primary care role:
1. Assess symptoms and conservative treatment options
2. Explain possibility of surgery: reduces patients attending for
conservative management and reduces pre-clinic anxiety
• Secondary care role:
1. Liaise with Primary Care Physicians and provide workshops
explaining the referral process
References
1. Hobby, J. Focus on: Carpal Tunnel Syndrome. Bone and Joint Journal
(Online Only) doi:10.1302/0301-620X.90B6.21534 [accessed 9/7/2013]
2. Reid, MJ; David, LA; Nicholl, JE. A one-stop carpal tunnel clinic. Ann R
Coll Surg Engl; 2009; 91; pp301–4.
3. Patterson, JD; Simmons, BP. Outcomes assessment in carpal tunnel
syndrome. Hand Clin; 2002; 18; pp359–63.
4. Ball, C; Pearse, M; Kennedy, D; Hall, A; Nanchahal, J. Validation of a
one-stop carpal tunnel clinic including nerve conduction studies and
hand therapy. Ann R Coll Surg Engl; 2011; 93(8); pp634–8.