scholarly journals A One-Stop Carpal Tunnel Clinic

2009 ◽  
Vol 91 (4) ◽  
pp. 301-304 ◽  
Author(s):  
MJ Reid ◽  
LA David ◽  
JE Nicholl
Keyword(s):  
Patient Satisfaction ◽  
Carpal Tunnel ◽  
Waiting Times ◽  
Cost Effective ◽  
Referral Letter ◽  
High Patient Satisfaction ◽  
One Stop ◽  
Tunnel Syndrome ◽  
Patient Consultation ◽  
Set Up

INTRODUCTION By December 2008, 90% of referrals requiring hospital admission will need to be seen and treated within the 18-week patient pathway. Previously, patients within our trust with suspected carpal tunnel syndrome had to wait 3 months to see a specialist in clinic and, once assessed, would have to wait up to a further 6 months for an open carpal tunnel decompression under local anaesthetic (OCTD/LA). We set up a one-stop clinic, where patients would have their out-patient consultation and surgery on the same day. We evaluated the clinic in order to assess whether it led to reduced waiting times whilst maintaining good clinical outcome and patient satisfaction. PATIENTS AND METHODS Patients were selected on the basis of the standard referral letter alone. Those selected were then assessed by a single surgeon in the clinic. The patients deemed appropriate underwent an OCTD/LA and were discharged the same day. Patients were followed up with a patient satisfaction and Boston questionnaire. RESULTS Forty-six patients underwent 63 OCTD/LA, waiting an average of 2.2 months (9 weeks) from referral. There was high patient satisfaction and improvement in symptoms following treatment in the clinic. CONCLUSIONS We believe a one-stop carpal tunnel clinic can be an efficient and cost-effective way of treating this common condition.

Development of a physiotherapy-led balance clinic: the Aintree model

2014 ◽  
Vol 128 (11) ◽  
pp. 966-971 ◽  
Author(s):  
A V Kasbekar ◽  
N Mullin ◽  
C Morrow ◽  
A M Youssef ◽  
T Kay ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Benign Paroxysmal Positional Vertigo ◽  
Waiting Times ◽  
Clinic Visit ◽  
Positional Vertigo ◽  
One Stop ◽  
Set Up ◽  
High Level ◽  
Referral Letters ◽  
Paroxysmal Positional Vertigo

AbstractObjective:To create a ‘one-stop’ clinic in which assessment, diagnosis, treatment and therapies for most patients presenting with balance and dizziness disorders are delivered simultaneously.Methods:Patients triaged via referral letters were selected to attend the balance clinic, which is led by specialist balance physiotherapists. Patients were seen by an audiologist, and a ‘balance’ ENT consultant was available for joint consultations when required. Further details of the clinic set up are discussed.Results:Over an 18-month period, 200 new ‘dizzy’ patients attended the clinic. Benign paroxysmal positional vertigo and labyrinthitis were the commonest diagnoses. Fifty per cent of all patients were discharged after a single clinic visit. Questionnaires showed that patient satisfaction was high.Conclusion:The physiotherapy-led balance clinic has reduced patient waiting times to be seen, has a high level of patient satisfaction and is economically beneficial.

scholarly journals Is one-stop surgery for carpal tunnel syndrome safe? A retrospective long-term follow-up study in a neurosurgical unit in Copenhagen

BMJ Open ◽  
2017 ◽  
Vol 7 (9) ◽  
pp. e016103
Author(s):  
Louise Møller Jørgensen ◽  
Karin Piil ◽  
Asma Bashir ◽  
Morten Bo Larsen ◽  
Pamela Santiago Poggenborg ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Symptom Relief ◽  
Follow Up Study ◽  
Long Term Follow Up ◽  
One Stop ◽  
Tunnel Syndrome

ObjectivesThe aim of this study was to evaluate one-stop surgery (OSS) for carpal tunnel syndrome (CTS) regarding symptom relief and patient satisfaction. OSS in our setting means only one visit to the hospital for surgery and no hospital appointments for preassessment or follow-up. We hypothesised that relief of symptoms with OSS is comparable with that in non-OSS patients reported in the literature.DesignThis is a long-term retrospective follow-up study (56.5 months) of 1003 patients referred for CTS and discharged with or without surgery from an OSS clinic. Of the original cohort, 671 patients completed the long-term follow-up telephone interview.ResultsTwo-thirds of the patients were free of even minor symptoms following surgery. The symptom relief and patient satisfaction in this study were comparable with results in non-OSS patients reported in the literature.ConclusionThe implementation of a clinical pathway and OSS for the management of CTS was safe with good long-term symptom relief and high patient satisfaction.

scholarly journals One-Stop Clinic Utilization in Plastic Surgery: Our Local Experience and the Results of a UK-Wide National Survey

2015 ◽  
Vol 2015 ◽  
pp. 1-8 ◽  
Author(s):  
Mark Gorman ◽  
James Coelho ◽  
Sameer Gujral ◽  
Alastair McKay
Keyword(s):  
Patient Satisfaction ◽  
Plastic Surgery ◽  
Waiting Times ◽  
Significant Proportion ◽  
High Patient Satisfaction ◽  
Local Experience ◽  
One Stop ◽  
Skin Cancer Surgery ◽  
Skin Surgery ◽  
The Uk

Introduction. “See and treat” one-stop clinics (OSCs) are an advocated NHS initiative to modernise care, reducing cancer treatment waiting times. Little studied in plastic surgery, the existing evidence suggests that though they improve care, they are rarely implemented. We present our experience setting up a plastic surgery OSC for minor skin surgery and survey their use across the UK. Methods. The OSC was evaluated by 18-week wait target compliance, measures of departmental capacity, and patient satisfaction. Data was obtained from 32 of the 47 UK plastic surgery departments to investigate the prevalence of OSCs for minor skin cancer surgery. Results. The OSC improved 18-week waiting times, from a noncompliant mean of 80% to a compliant 95% average. Department capacity increased 15%. 95% of patients were highly satisfied with and preferred the OSC to a conventional service. Only 25% of UK plastic surgery units run OSCs, offering varying reasons for not doing so, 42% having not considered their use. Conclusions. OSCs are underutilised within UK plastic surgery, where a significant proportion of units have not even considered their benefit. This is despite associated improvements in waiting times, department capacity, and levels of high patient satisfaction. We offer our considerations and local experience instituting an OSC service.

scholarly journals Validation of a one-stop carpal tunnel clinic including nerve conduction studies and hand therapy

2011 ◽  
Vol 93 (8) ◽  
pp. 634-638 ◽  
Author(s):  
C Ball ◽  
M Pearse ◽  
D Kennedy ◽  
A Hall ◽  
J Nanchahal
Keyword(s):  
Patient Satisfaction ◽  
Carpal Tunnel Syndrome ◽  
Grip Strength ◽  
Carpal Tunnel ◽  
Nerve Conduction ◽  
Operating Time ◽  
Nerve Conduction Studies ◽  
Patient Reported ◽  
One Stop ◽  
Tunnel Syndrome

INTRODUCTION Carpal tunnel syndrome is the most common hand disorder. We describe a pathway that includes clinical assessment, neurophysiological testing, surgery and physical therapy all at the same visit. METHODS All referrals for carpal tunnel syndrome were screened for inclusion in a ‘one-stop’ surgeon-led clinic. Prospective clinical data collected included patient reported outcome measures and satisfaction scores, touch threshold, pinch and grip strength. Patients were assessed clinically, underwent nerve conduction studies and surgery as indicated, all on the same day. Baseline and one-year follow-up data were analysed for 57 patients (62 hands). RESULTS There was significant improvement in all domains of the Boston Carpal Tunnel and Michigan Hand Outcomes questionnaires, grip strength and touch threshold. There were no adverse events. The total mean operating time was 12.8 minutes (range: 5–15 minutes) and the mean tourniquet time was 2.5 minutes (range: 1–11 minutes). Using a dual theatre model produced a short mean turnaround time of 14.8 minutes (range: 2–37 minutes). Patient satisfaction as judged using a Picker questionnaire was very high. CONCLUSIONS A highly efficient clinical service involving both diagnostics and treatment can be delivered at a single hospital visit while maintaining optimal outcomes and high patient satisfaction.

scholarly journals Assessing the Feasibility of a One-Stop Approach to Diagnosis for Urological Patients

2009 ◽  
Vol 91 (4) ◽  
pp. 305-309 ◽  
Author(s):  
Nadine Coull ◽  
Giles Rottenberg ◽  
Sheila Rankin ◽  
Maria Pardos-Martinez ◽  
Bola Coker ◽  
...  
Keyword(s):  
Shock Wave Lithotripsy ◽  
Cost Effective ◽  
Standard Of Care ◽  
Referral Letter ◽  
Urinary Flow ◽  
Publicly Funded ◽  
Extracorporeal Shock Wave ◽  
Effective Care ◽  
One Stop

INTRODUCTION Conventional publicly funded out-patient services in many specialties are characterised by delays, fragmented diagnostic processes, and overloaded clinics. This is bad for patients as it is clinically dangerous; bad for managers who spend hours managing the failure; bad for doctors who respond by overloading clinics; and bad for purchasers who have to fund the multiple out-patient visits needed. Sound clinical and financial reasons exist for introducing more efficient diagnostic processes. PATIENTS AND METHODS A total of 330 consecutive patients referred to the urology department of Guy' and St Thomas' NHS Foundation Trust were invited to attend one of nine one-stop clinics staffed by consultant urologists with specialist registrars, nurses, and clerical staff. Pre-clinic blood and urine tests were ordered based on the referral letter. Clinics had facilities to perform cystoscopy, ultrasound, and urinary flow studies. Correspondence was generated in real time, and a copy given to the patient. RESULTS Overall, 257 patients attended the clinics. Twenty-three patients cancelled appointments and 50 patients did not attend. Pre-clinic tests were requested in 133 patients and were completed by 86% of the patients who attended. Of patients, 42% were diagnosed and discharged; 28% were listed for surgery, extracorporeal shock wave lithotripsy (ESWL), or referred to another specialty. About 30% of patients needed further out-patient review; in approximately two-thirds to complete a diagnosis and one-third to review the results of therapy initiated. An estimated 350 appointments and 550 patient visits to hospital were saved. CONCLUSIONS A one-stop method of consultation is efficient across a range of urological presenting complaints, and dramatically reduces the need for follow–up consultations. It has potential to: (i) reduce delays to being seen in out-patients; (ii) lead to more cost-effective care; and (iii) increase safety and patient satisfaction. It should become the standard of care in urology, and is probably applicable in many other disciplines.

scholarly journals Setting up an arthroplasty care practitioner-led virtual clinic for follow-up of orthopaedic patients

2019 ◽  
Vol 28 (20) ◽  
pp. 1326-1330 ◽  
Author(s):  
Sharon Ferdinandus ◽  
Lindsay K Smith ◽  
Hemant Pandit ◽  
Martin H Stone
Keyword(s):  
Patient Satisfaction ◽  
Teaching Hospital ◽  
Waiting Times ◽  
Cost Savings ◽  
University Teaching ◽  
Local Hospital ◽  
X Ray ◽  
Orthopaedic Patients ◽  
Set Up

This article provides an overview of the set up for an arthroplasty care practitioner (ACP)-led virtual orthopaedic clinic (VOC). Suitable patients attend a local hospital for an X-ray and complete a questionnaire, but do not physically attend a clinic. This has been running successfully in a university teaching hospital and has led to cost savings, a reduction in outpatient waiting times and high levels of patient satisfaction. Similar clinics have the potential to become normal practice across the NHS. This article outlines the steps necessary to implement a successful VOC. The lessons learnt during this exercise may be useful for other ACPs when setting up a VOC.

scholarly journals Nurse-Led Management of Carpal Tunnel Syndrome: An Audit of Outcomes and Impact on Waiting Times

2006 ◽  
Vol 88 (4) ◽  
pp. 399-401 ◽  
Author(s):  
Martyn Newey ◽  
Malcolm Clarke ◽  
Tim Green ◽  
Christopher Kershaw ◽  
Pankaj Pathak
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Nurse Practitioner ◽  
Waiting Times ◽  
Presumptive Diagnosis ◽  
Clinic Appointment ◽  
Access Service ◽  
Tunnel Syndrome

INTRODUCTION This article describes the outcome of a nurse-led service developed to manage patients referred with a presumptive diagnosis of carpal tunnel syndrome. PATIENTS AND METHODS We developed a rapid-access service in response to unacceptable waiting times for patients with carpal tunnel syndrome. The service was developed around the role of a nurse practitioner providing a single practitioner pathway from first clinic appointment, through surgery to discharge. RESULTS Waiting times improved considerably whilst the standard and quality of care was maintained. CONCLUSIONS There is a role for nurses to perform certain surgical procedures within a well-defined environment.

scholarly journals Ultrasound as a diagnostic tool in the investigation of patients with carpal tunnel syndrome

2018 ◽  
Vol 28 (2) ◽  
Author(s):  
Leila Kanafi Vahed ◽  
Afshin Arianpur ◽  
Mohammad Gharedaghi ◽  
Hosein Rezaei
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Clinical Symptoms ◽  
Cost Effective ◽  
Time Saving ◽  
Cross Sectional ◽  
Clinical Criteria ◽  
Flexor Retinaculum ◽  
Tunnel Syndrome

Carpal tunnel syndrome (CTS) is reveled to be the most common peripheral nerve entrapment syndrome, estimating for 90% of all compressive. The diagnosis of CTS is based on the use of clinical criteria and imaging technique tests such as ultrasonography (US) and magnetic resonance imaging (MRI). US is a time-saving method in the diagnosis of CTS, which induces less discomfort to the patient and may be a more cost-effective approach to confirm clinical suspicion of this syndrome .The current study was aimed to evaluate the value of US and physical examinations in the diagnosis of CTS. This cross-sectional and cross-sectional prospective case study was conducted to evaluate the usefulness of wrist ultrasonography in diagnosing CTS. Twenty one patients (21 wrists) were invited to participate in the study along with an age- and sex-matched group of participant controls. Physical examination included Phalen, Tinel, Durkan, Tourniquet test. Anteroposterior and mediolateral dimension of carpal tunnel, and the median nerve area at the tunnel were also measured. All the patients underwent the open surgical release of the flexor retinaculum. There was a significant statistical relationship (p=0.05) between anteroposterior diameter of the carpal tunnel and clinical and electro physiologic nerve involvement. Furthermore, some qualitative findings was achieved such as median nerve splitting, hypo echogenicity of the involved nerve, thickening of flexor retinaculum and disappearance of median nerve areas (especially mediolateral direction). In conclusion, ultrasonographic examination of the wrists in the patients with suspected clinical symptoms can improve the diagnostic ability of CTS, especially by improving technology and experience. US can be applied for the median nerve area (MNA) measurement as a first line technique in patients with CTS.

scholarly journals Daycase trauma list: a safe and cost-effective service delivery

2019 ◽  
Vol 101 (7) ◽  
pp. 519-521
Author(s):  
MS Athar ◽  
MA Fazal ◽  
N Ashwood ◽  
G Arealis ◽  
D Buchanan ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Lower Limb ◽  
Trauma Surgery ◽  
Cost Effective ◽  
High Patient Satisfaction ◽  
Trauma Service ◽  
Novel Approach ◽  
Wide Range ◽  
The Mean ◽  
Effective Service

Introduction Daycase trauma surgery is an evolving and a novel approach. The aim of our study was to report our experience of daycase trauma surgery with a focus on safety, patient experience, complications and limitations. Material and methods Patients scheduled and operated on a daycase trauma list from January 2013 to December 2016 were included in the study. Age, sex, case mix, readmissions within 48 hours, complications, patient satisfaction, reasons for overnight stay and cost effectiveness were evaluated. Results A total of 229 procedures were carried out. The mean age of the patients was 44.3 years (range 16–85 years) . There were 128 men and 101 women, 178 upper-limb and 51 lower-limb cases. Only 2.6% of the patients had stayed overnight for pain control, physiotherapy and neurological observations; 94.5% of the patients were satisfied. The mean visual analogue scale score for satisfaction was 8.7. There were no admissions within 48 hours of discharge and one complication with failure of ankle fixation. The estimated cost saving was £65,562. Conclusion We conclude that a daycase trauma service is safe, cost effective, and yields high patient satisfaction. It reduces the burden on hospital beds and a wide range of upper- and lower-limb cases can be performed as daycase trauma surgery with adequate planning and teamwork.

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