Burton Christopher, Palmer Michelle A, Fanton Lauren, Cox Ruth, Wishart Laurelie R
Queensland Health, Logan Hospital, Meadowbrook, Queensland, Australia.
Queensland Health, Logan Hospital, Meadowbrook, Queensland, Australia.
J Hand Ther. 2022 Oct-Dec;35(4):655-664. doi: 10.1016/j.jht.2021.06.007. Epub 2021 Jul 29.
Prospective cohort design.
Patient time on Australian public hospital surgical outpatient department (SOPD) waitlists often exceeds clinical recommendations for chronic hand conditions. Diversion to allied health is an alternative option, however evidence regarding patient and organizational outcomes in hand therapy is lacking.
To evaluate clinical and organizational efficacy, patient outcomes and satisfaction of diversion of referrals for patients with trigger digit (TD) from SOPD waitlists to Advanced Practice Hand Therapy (APHT) at 3 Australian hospitals.
Data was collected from eligible patients with TD through chart reviews and telephone satisfaction surveys. Data included number of patients requiring SOPD review, repeat referral to SOPD in the 12 months following APHT discharge, patient-rated outcomes, satisfaction scores, wait times to SOPD review and conversion to surgery-rates. Mann Whitney-U, t-test, Pearson's chi-squared test and a Binary Logistic Regression analysis were performed.
104 patients completed APHT treatment. Seventy patients (67%) did not require return to the SOPD waitlist. Repeat referral to SOPD within 12 months of APHT discharge occurred for only 1 patient. Patients requiring SOPD review after APHT treatment were seen within target time frames and demonstrated 88% conversion to surgery-rates. Michigan Hand Outcome Questionnaire scores showed greater improvement in those not requiring SOPD review (P< .001~25.9 vs 4.2). Regression analysis identified a negative association between initial total Michigan Hand Outcome Questionnaire scores and unfavorable discharge outcomes (OR 0.96, P= .007). Most (81%-93%) patients indicated satisfaction with the APHT service.
Diversion of referrals for TD from SOPD to APHT is an effective waitlist management strategy, with the propensity to reduce waiting times, improve patient flow, whilst resulting in favorable clinical and patient-rated outcomes and satisfaction.
前瞻性队列研究设计。
澳大利亚公立医院外科门诊候诊名单上患者的等待时间往往超过慢性手部疾病的临床建议时长。转诊至联合健康服务是一种替代选择，然而，关于手部治疗中患者和组织结局的证据尚缺。
评估澳大利亚3家医院将扳机指（TD）患者从外科门诊候诊名单转诊至高级实践手部治疗（APHT）的临床和组织疗效、患者结局及满意度。
通过病历审查和电话满意度调查收集符合条件的扳机指患者的数据。数据包括需要外科门诊复查的患者数量、APHT出院后12个月内再次转诊至外科门诊的情况、患者自评结局、满意度评分、外科门诊复查等待时间及手术转化率。进行了曼-惠特尼U检验、t检验、皮尔逊卡方检验和二元逻辑回归分析。
104例患者完成了APHT治疗。70例患者（67%）无需重回外科门诊候诊名单。APHT出院后12个月内仅有1例患者再次转诊至外科门诊。APHT治疗后需要外科门诊复查的患者在目标时间范围内得到诊治，手术转化率达88%。密歇根手部结局问卷评分显示，无需外科门诊复查的患者改善更明显（P<0.001，25.9对4.2）。回归分析确定密歇根手部结局问卷初始总分与不良出院结局之间存在负相关（比值比0.96，P = 0.007）。大多数（81%-93%）患者对APHT服务表示满意。
将扳机指患者从外科门诊转诊至APHT是一种有效的候诊名单管理策略，有减少等待时间、改善患者流程的倾向，同时能带来良好的临床和患者自评结局及满意度。
