The impact of referral quality on conversion rates at the one-stop Carpal Tunnel clinic

Abstract

Purpose/Theory: One-stop carpal tunnel clinics integrate Primary and Secondary Care and reduce waiting times to surgery by incorporating surgical and neurophysiology consultations into a single clinic for patients with suspected Carpal Tunnel Syndrome (CTS). Patients are selected from Primary Care referrals by Consultant Orthopaedic Surgeons as those with a high likelihood of CTS. This study aims to investigate referral quality and whether this impacts on clinic efficiency. Methods: Retrospective screening of Primary Care referrals and correlation with neurophysiology reports. Referrals that included detailed sensory symptoms and mentioned specific exclusion criteria were considered adequate. Exclusion criteria chosen were age>75, ulnar sensory symptoms, Diabetes Mellitus, previous wrist fracture, Rheumatoid Arthritis, and hand muscle wasting. Findings: 58 referrals identified over a 7-month period. 18/58 (31%) had sufficiently detailed referrals. 28 patients in total were listed for surgery giving a conversion rate of 48% for our clinic. Discussion: Our conversion rate is lower than expected and could be increased by improving referral quality, ensuring only patients with a high likelihood of CTS attend. In order to further integrate Primary and Secondary care provision in this context it is vital to improve awareness of referral criteria for our clinic amongst Primary Care Physicians.