A NURSE-LED CARPAL TUNNEL SYNDROME ASSESSMENT CLINIC: COULD WE COMMEND ITS ADAPTATION AND IMPLEMENTATION?

Abstract

Objective: This article describes the outcome of a nurseled service developed to manage patients referred with a presumptive diagnosis of carpal tunnel syndrome. We also describe the implementation of a nurse-led preoperative assessment and postoperative care clinic.

Design: We assess the safety, efficacy and outcomes of 402 patients referred to the Department of Orthopaedic, University Hospital Lewisham for carpal tunnel decompression surgery prospectively.

Patients and Methods: The service was developed around the role of a nurse practitioner providing a single practitioner pathway from first clinic appointment to discharge. General practitioners were advised of the service and the criteria for referral, which included patients with symptoms and physical signs, and some response to conservative treatment.

Patients were assessed in the nurse-led preoperative assessment clinic and those deemed suitable for surgery were listed for operation.

Results: 12.7 % patients (51 patients) were referred for electromyographic studies and 5.2% patients (21 patients) were referred to doctors for further consultations. Only 4 patients had trigger finger and a further 4 patients had De Quervians syndrome. Of the remaining 373 patients, 7 patients (1.8%) choose to wait before considering surgery, and 2 patients (0.5%) declined surgery.

Waiting times improved considerably whilst the standard and quality of care was maintained.

Conclusions: We developed a rapid-access service in response to unacceptable waiting times for patients with carpal tunnel syndrome. Implementing such a clinic improved access to care for patients with this particular problem. The safety and efficacy of the program and patient-centred outcomes commend its adaptation and implementation to other institutions.

As the clinical diagnosis of Carpal tunnel syndrome is often easily made, a system of direct referral for carpal tunnel surgery was introduced. The service was an alternative to standard consultants’ outpatient referral. Direct access to a nurse-led carpal tunnel syndrome assessment clinic works well and it will reduce delays and the costs of treatment. Adequate patient information is vital to make the best of the service. There is a role for nurses to perform certain clinic within a well-defined environment.