Reid M J, David L A, Nicholl J E
Department of Orthopaedics, Kent and Sussex Hospital, Maidstone and Tunbridge Wells NHS Trust, Royal Tunbridge Wells, Kent, UK.
Ann R Coll Surg Engl. 2009 May;91(4):301-4. doi: 10.1308/003588409X391910. Epub 2009 Feb 13.
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 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.
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.
We believe a one-stop carpal tunnel clinic can be an efficient and cost-effective way of treating this common condition.
到2008年12月,90%需要住院治疗的转诊患者需在18周的患者就医流程内得到诊治。此前,我们信托机构中疑似腕管综合征的患者需等待3个月才能在门诊见到专科医生,且一旦完成评估,还需再等待长达6个月才能接受局部麻醉下的开放性腕管减压术(OCTD/LA)。我们设立了一站式诊所,患者可在同一天进行门诊咨询和手术。我们对该诊所进行了评估,以确定其是否能在保持良好临床效果和患者满意度的同时缩短等待时间。
仅根据标准转诊信选择患者。所选患者随后由诊所的一名外科医生进行评估。被认为合适的患者接受了OCTD/LA,并于当天出院。通过患者满意度问卷和波士顿问卷对患者进行随访。
46例患者接受了63次OCTD/LA,从转诊到手术平均等待2.2个月(9周)。诊所治疗后患者满意度高,症状改善。
我们认为一站式腕管综合征诊所是治疗这种常见疾病的一种高效且具成本效益的方式。