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.

Introduction: Doctors spend less consultation time giving information to the patients [Cegala] and underestimate the patients’ desire for information [Teutsch C 2003]. The communication gap is more visible when people with chronic arthritis present themselves for treatment. This also may initiate medico legal claims in NHS.

We aim to set up a nurse practitioner clinic to bridge the gap. Secondary aim is to reduce patients’ complaint about the services.

Materials: 100 questionnaires filled up by the patients on the waiting list for joint replacement, attending the specified clinic over a period of 24 months were randomly selected for analysis. Equal no of males and females were taken to eliminate gender bias on the outcome.

Methods: Patients were given detailed generic information about pre and post surgery nursing care, the operative steps and complications. They were asked to fill up 6 item questionnaires to assess the qualitative aspect of service at the end of the clinic and another 12 item questionnaires to fill up separately 6 weeks prior to their operation.

Result: 98% reported the information provided is excellent. 93% reported the clinic is excellent, as they have been told about the complication and pre and post surgery events. There is a reduction of rate of cancellation of elective joint replacement surgery from12.4% to 4.6%

Conclusion: This kind of informal group discussion enable patients with arthritis needing joint replacement to get information and aware of the kind of support available to cope in the community. We found there is a reduction of patients’ complaints about the service and effectiveness of this programme in reducing postoperative complications and use of bed days, use of own transport to return home. This may potentially lessen financial burden to the care provider.

Inappropriate use of surgical dressing cause blisters around the surgical wound and increase the incidence of peri-operative wound infection and patients dissatisfaction which influence the outcome of the surgery. It is more so when patients are being treated as a day case procedure. We have not found any study correlating with patient’s satisfaction and surgical dressing.

Objective: To evaluate patient’s preference of surgical dressing and analyse which type of dressing is associated with significant morbidity

Design: Prospective, Non randomised, Clinical study.

Materials and Methods: Two different dressings Opsite post op or Mepore were applied by a single surgeon on 100 patients (50 each group) undergoing same arthroscopic procedure of the knee under general anesthetic were included in this study. They were followed up to 10 days. An independent nurse practitioner evaluated the complication related to the dressing and assessed the satisfaction with the 5 item short questionnaires at outpatients clinic.

Results: Blisters developed in 6% of patients with Mepore dressing (p=0.24) and none with Opsite Post op. 14% Patients with Mepore dressing developed superficial inflammation and this is significantly greater (p< 0.001) than opsite. 86% patients with opsite dressing on were able to take bath and thereby reduce the chance of contamination from the skin flora. 90% patients with opsite rated the dressing as excellent compared to mepore 26%, (p< 0.001)

Conclusion: Patients preferred Opsite post op as the dressing of their choice. It is not associated with dressing related morbidity, may improve better post operative wound healing. It may help to prevent superficial wound infection by contamination. After this study, we have changed our policy.