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.