At first reading, this one-stop carpal tunnel clinic sounds impressive. Having considered doing something similar myself, I was always put off by the fact that patients would be reluctant to attend a clinic not knowing for certain whether they were going to have an operation and having to make domestic and work arrangements ‘just in case’. I read this paper in the hope of finding out how to get around this.
Although the authors claim of 78% success rate in correctly predicting those who would require surgery, nearly half the patients had nerve conduction studies done prior to attending the clinic, which were presumably ordered by other specialists or their general practitioners. For this very significant part of the study group, therefore, this was not strictly speaking a one-stop clinic.
Do the authors know what percentage of the total number of genuinely first-time referrals agreed to come to the clinic? Did the patients who agreed belong to a particular group of patients (e.g. retired people), whose schedule is somewhat more flexible than that of patients of working age?
Finally, the arrangements seem to have been that the surgeon started off for a hour in the clinic and then left the clinic to operate on the patients in theatre. Does this mean that the theatre was standing idle whilst the surgeon was in the clinic and that the clinic was not being used whilst he was operating? This is undoubtedly a good service for patients but are there hidden costs?
Footnotes
COMMENT ON doi 10.1308/003588409X391910 MJ Reid, LA David, JE Nicholl. A one-stop carpal tunnel clinic. Ann R Coll Surg Engl 2009; 91: 301–4