CARPAL TUNNEL SYNDROME

1
CARPAL TUNNEL SYNDROME

• QUALITYMK

2
AIMS OF THE PROJECT

• TO DEVELOP A CONSISTENT EVIDENCE-BASED APPROACH
  TO THE TREATMENT OF CARPAL TUNNEL SYNDROME

3
PROCESS

• Evidence-based Discussion Group-What is the best
  
• 
  treatment?
• Map of Medicine
• Current Practice (Discussion with GPs and
  auditing patient records)
• -splints
• -injections
• -referral for surgery-nerve conduction studies
• Patient satisfaction questionnaire

4
Current State Map
Total population 15-65 8249 Prevalence 3
248 (April 2007)
Injections
1
Splints
Only if patient still requires further treatment
4
Nerve conduction study
Follow up with GP
Treatment plan complete
8
Visit to GP
22
4
Watchful waiting
7
6
Hand therapy
0
Orthopaedic opinion
7
Surgery
32 days (NCS)
14 days (NCS)
48 hrs
98 days
210240 mins
60 mins (OPD Op)
0.05 value
30 mins (NCS)
10 mins
10 mins
110 mins
Slide 1
5
RESULTS

• 6 GPS All do it differently
• Injection only offered if GP had that skill
  despite having musculoskeletal expert in the
  practice.
• Referral likely to result in surgery

6
Current State Map - comments
Total population 15-65 8249 Prevalence 3
248 (April 2007)
Dont doenough, so refer
GPwSI reimbursement
Length of time
Injections
Injections dont work,so refer
Varyingpractice
Splints
Only if patient still requires further treatment
Nerve conduction study
Follow up with GP
Treatment plan complete
Visit to GP
Access thruCB?
Watchful waiting
Hand therapy
Orthopaedic opinion
Surgery
Slide 2
7
Map of Medicine (summary)
QualityMK
Guidelines for NCS
Timelinessafter referral
Clarity on exclusions
Non-typical symptoms
CTS not diagnosed
Other management
Impair abilityto function
Surgery
No underlying cause
Nerve conduction study
CTS confirmed
Visit to GP
Typical symptoms
Conservative Management
Conservative management
Does not impair abilityto function
Underlying cause
Make useof GPwSI
Symptoms resolve
Treat cause
All patientsto have NCSbefore referral
Use splints forsymptom control(when not fit
for surgery)
Pts have to return for Injn
One stopservice
Slide 3
8
DESIRED OUTCOME

• Evidence based approach clear patient pathway
• In house injections for all appropriate patients
• Referral for those with severe symptoms or where
  injections failed
• Potential to offer CTS injections to patients of
  other practices-
• One stop clinic for patients requiring surgery
  including nerve conduction studies close to home

9
Proposed service development
Non-typical symptoms
CTS not diagnosed
Other management
One stop service
Impair abilityto function
Surgery
Conservative Management Injections by GPwSI
No underlying cause
Nerve conduction study
CTS confirmed
Visit to GP
Typical symptoms
Conservative management
Does not impair abilityto function
Underlying cause
Symptoms resolve
Treat cause
43200 mins
48 hrs
28 days
0.58 value
10 mins
4 hours?
250 mins
Slide 4
10
SUCCESS

• Using the evidence to decide best treatment for
  patients
• Stimulating clinical discussion groups
• Use of expertise of GP with musculoskeletal
  expertise to benefit patients.
• Potential income generation for practice
• Primary Care led service