Overview Leicester Carpal Tunnel Service

Sunday, September 16, 2007

This was one of the first blog post concerning Mediracer. Wanted to take it up and back to the front page.

Three and a half years ago the Carpal Tunnel Service at Leicester was approached by the Finnish Government via the Department of Health seeking help with a new piece of Neuro physiology equipment that it was hoped would speed up access to NCS and would reduce waiting times and cost less to perform.

The equipment was easy to use and could be operated by a nurse or any healthcare worker trained in its use. More information can be obtained by contacting:

malcolm.clarke@uhl-tr.nhs.uk
Phone UK 07894 833310

The University Hospitals of Leicester

A study made in Leicester in February 2007 . I'll write more about this when I've a chat with Veijo Lesonen. Details to be found in powerpoint presentation. Download ppt.

Delivering the 18 week Patient Pathway

• 17th July 2007 by Malcolm Clarke
• Can it be done?
• By whom?
• When?
• How?

The Leicester Experience

• Overview Leicester Carpal Tunnel Service
• Traditional ways of working
• The Leicester Experience
• Traditional NCS in U.K.
• New Method of NCS
• Anglo-Finnish Collaboration
• Results /Audit
• Nurse Operating

Overview Leicester C.T.Service

• Nurse Led service
• 850 Operations per year
• 1100 New patients
• 1200 Follow-ups
• Average back to work post op 4 Days
• 12wks from referral to discharge

Traditional Ways of working

• Totally Ineffective
• Costly (wasteful Tax payers Money)
• Overkill on Resource (Theatre, Day Bed)
• Overuse of Manpower (Doctors, Nurses,Admin)
• Not Patient Friendly (Intimidating not Natural)
• Time Consuming ( Too Many Handoffs)

The Leicester Experience

• Highly Effective
• Value for Money (No Bed, No Theatre)
• Minimum Resource (Treatment Room )
• Small Manpower Resource (3People)start to finish
• Extremely Patient Friendly (Non Threatening)
• Time Effective ( Fast, Efficient Patient Pathway)

Savings to be Made being Effective

• No Bed £250 per half day
• Theatre £400 per half hour
• N.C.S £160 per Test

Traditional N.C.S. U.K.

• 16-20 Week Wait and can be much longer
• Cost between £120-£400 per test
• Referral to different hospital
• Not nice test for patient
• Long Referral to Discharge
• Totally Unacceptable

Anglo-Finnish Collaboration

• Leicester-Oulu
• 65 Patients
• All Traditional and Mediracer Tests
• 61 Operations for CTD
• 6mth Follow-up Mediracer (Sept 2006)

Results submitted for Publication

• Results/Audit Nurse Operating
• 3500 Operations
• 6000 New Referrals
• 8000 Follow-ups
• 97.8% Success Rate
• 2% Complication Rate
• High Patient and GP satisfaction rate

New Method of NCS

• No Wait (Test at 1st Appointment)
• Costs about £25-£30 for disposables
• No Referral to other Hospital required
• Comfortable for patient
• Results at 1st Appointment
• Treatment Discussed

Outcome

• Completion of Whole Treatment inside the 18 week timeframe.
• Guaranteed For all Patients
• Happy Patients/Relatives/Clinicians
• Shorter Waiting Lists
• Quality deliverance of care
• Hospitals able to tick the box
• Government achieve projected goals and claims

Early return to work

• £76.40 per day CBI Figures
• Sick pay, Lost Productivity,Loss of Tax
• 100 patients/ 75 working age
• 6 weeks off work/ 2 weeks off work
• £240,660 / £80,220
• 42,000 Ctd per year = Savings
• £67,384,800.00 one condition
• Smarter Thinking + Early return to work
• = Savings of £91,114,800.00 Minimum for the condition of Carpal Tunnels alone

The Future

• Patients treated in a one-stop Pathway
• No limit on patients treated
• No making patients wait 18 weeks
• Money saved invested back into services
• Safe guarding the NHS

Summary

• Clinically Led -Patient focussed services
• Nurse Led/Others from referral to discharge
• Large input on patient Comfort/Satisfaction
• Do use Cost Effective methods for Tests and Surgery
• Do not use theatres ( Usually £800 per hour)
• Do not use beds ( Usually £250 per half Day)
• Early Return to Work+Change of Practice could save a minimum of £100 Million