Handchir Mikrochir Plast Chir 2014; 46(01): 67
DOI: 10.1055/s-0033-1363967
Letter to the Editor
© Georg Thieme Verlag KG Stuttgart · New York

“The Wide-Awake Approach” – Just One Step to a Streamlined Carpal Tunnel Release Service

„Der Wide-Awake Approach“ – Ein Schritt in Richtung patientenfreundlicher Karpaltunneloperation
P. Mahapatra
1   Plastic Surgery, St George’s Hospital, London, United Kingdom
,
E. Ieong
2   Trauma & Orthopaedics, Charing Cross Hospital, London, United Kingdom
,
H. Belcher
3   Plastic Surgery, Queen Victoria Foundation Trust Hospital, East Grinstead, United Kingdom
› Author Affiliations
Further Information

Publication History

Publication Date:
26 February 2014 (online)

Dear editor,

I was very interested to read your recent article by Löw S et al. [1]. Their new “Wide-Awake Approach” indeed appears to have significantly improved the efficiency of their service without compromising patient safety. However, we feel that this is not necessarily the whole story. In order to run a truly organised and streamlined service all aspects of a patient’s care pathway must be co-ordinated. It is of no use being able to increase operative throughput if pre and post-operative care models are unable to cope with the increased demands. In our institution, we focused on rationalising our post-operative care model.

In our institution there were 2 follow up regimens in place for carpal tunnel release. In one regime patients had follow up appointments arranged post operatively. In the other regime patients were discharged post operatively and allowed to arrange their own follow up if any problems were encountered. The patients were allocated to a follow up regime based on consultant preference.

The patients were all sent a questionnaire four months after their initial operation. The questionnaire was divided into 3 major components:

  1. The patient’s assessment of their function, pain and appearance scores post operatively

  2. The patient’s general satisfaction regarding the surgery and the service provided

  3. Whether they felt that it was necessary or beneficial to have a pre-arranged follow up

In total, 14 patients were recruited in the follow up group, and 36 patients recruited in the discharged group. There was no significant difference in demographics between the 2 groups. We found there were no significant differences (using Mann-Whitney U test) in all aspects of satisfaction scoring between the 2 groups of patients, both on a service level and clinical satisfaction. Patient’s satisfaction scores ranged from very good to excellent.

Of note, 86% of patients found pre-arranged follow up to be useful. But what is also interesting is that 97% of patients were happy to be discharged post operatively without a routine follow up being arranged. 12 out of 36 patients had arranged follow up themselves after being discharged immediately post operatively, but all of them were still happy to have been discharged without planned specialist follow up. 6 of these patients had very minor problems that were dealt with by their family doctor in the community and did not require referral back to the specialist team.

With these findings, we proposed a system of open appointments post carpal tunnel decompression, without the requirement for routine specialist follow up. Combining this strategy with the “Wide-Awake Approach” may help pa­tient throughput and minimises pressure on specialist outpatient clinics that will be generated by the new approach proposed by Löw S et al. It is prudent, however, to remember that follow up should always be tailored to the individual patient’s needs and circumstances, and that is some cases it may be sensible to bring a patient back for routine follow up for one reason or another.

 
  • References

  • 1 Löw S, Herold D, Eingartner C. Der „Wide-Awake Approach“ – Effizienz und Patientensicherheit bei der Karpaldachspaltung. Handchir Mikrochir Plast Chir 2013; 45: 271-274