Dr Gareth James ASPC Audit lead Carpal Tunnel Audit Dr Gareth James ASPC Audit lead free to email me GtbVas@Yahoo.co.uk Or grab me in the Coffee breaks!!

Why Audit? To improve you have to firstly see how you compare to others and their outcomes…don’t you want to be the best you can? The collected audit data will allow us – the ASPC and it’s members - to get comparison results on a yearly basis. This you can compare with your peers and will be presented at the following ASPC conference. So this data doesn’t just tell you “how am I driving” but also “how am I driving compared to the other road users”. Taking part in the ASPC CTS Audit will also show evidence of ongoing CPD in field of Carpal Tunnel Operation, with a certificate for your PDP CCG’s want your audit data!

A quick reminder…. The ASPC decided to use the PEM Hand Health Questions (this should NOT be routinely used for diagnostic purposes) And to use 3 patient questionnaires…

CTS QUESTIONNAIRE ONE - CTS PRE-OP This is the 11 questions from just Part 2 of the PEM Hand Health Questions This should be sent to the patient at the same time as their appointment details and/or information leaflet Ask the Patients to bring it completed on the day of their operation. If they arrive without, then ask them to complete in the waiting room this prior to their surgery Score their PEM 1 (Pre-Op) by adding together the patients number answers for each of the 11 questions into one total (out of 77)

CTS PRE-OP The Hand Health Questions

CTS QUESTIONNAIRE 2 - CTS IMMEDIATE POST-OP To be filled straight after the operation: Just 4 questions:

CTS QUESTIONNAIRE 3 - CTS POST-OP These should be sent out to the patient 3 months Post Operation Or contact the patient another way – phone them up? This one has the PEM Hand Health Questions (part 2) to fill out again Score their PEM 2 (Post-Op) by adding together the patients number answers for each of the 11 questions into one total (out of 77)

CTS POST-OP PEM Part 2 again The Hand Health Questions

CTS POST-OP Questionnaire Page 2 Plus there another 5 questions, these will be THE MAIN BASIS OF YOUR KNOWLEDGE OF YOUR COMPLICATION RATES

How to Score #1 – PEM Post Op Difference The difference from the first Pre-op total (PEM1) to the Post-op total (PEM2) will be our VALIDATED total called the PEM Post Op Difference (PEM PoD) Patients name, or identity number needs to be on both Pre and Post questionnaires GDPR issues…. This Audit asks for your AVERAGE PEM PoD Score for all your patients But you should be following up:- Patients with a minus or static PEM PoD score (obviously have not done well) Any patient with any severity still scoring 7. The commonest reason is either the Pre-Op CTS was very severe with irreversible nerve damage or the hand has collateral pathology which accounts for on going disability.

Audit cycle time frame The audit cycle runs for 12 months covering the periods 1st January until 31st December Collection of that year’s data for the following years Conference presentation The 2018 audit cycle started 1st Jan 2018 until 31st Dec 2018 and will be presented in the next slides Data from 2019 should be now being collected and will be presented at the 2020 conference

2018 CTS Audit results I had data from 8 practices Previous years 4, 9 This means we have data on some 1840 CTS operations Previous years 759, 2089

201 CTS Audit results – Return Rates What percentage Returns rates are you getting? Pre-op: Average 67%. Previous years %: 81, 64 Not sure why this isn’t 100%. You need this for you PEM PoD score…get them to do it on the day otherwise if they don’t bring it before their operation On the Day: Average 68% Previous years %: 79, 80 Again why not higher, they cant leave the building until its done! Post op: Average 41% Previous year %: 46, 49 Not too bad. You can just get someone to phone them and do the form…. The average PEM PoD score was 22 Previous years: 21, 27

Audit results – On the day Questionnaire Average scores for the below questions: rated 1 (Excellent) to 7 (Very Poor) How good was the information leaflet sent to you prior to your appointment to prepare you for today’s operation? Average Score 1.2 Previous years: 1.1, 1.1 2. How did you rate the Doctor's manner and communication during the operation? Average Score 1.1 Previous years: 1.0, 1.1 3. What was your overall impression of having your Carpal Tunnel Operation undertaken here at this Clinic? Average Score 1.1 Previous years: 1.0, 1.2 4. How many said VERY LIKELY to: How likely are you to recommend our clinic to friends or family if they needed similar care or treatment? Average percentage 95% Previous years %: 95, 91

Audit results – Post-Op Questionnaire Average scores for the below questions: rated 1 (excellent) to 7 (poor) following the Hand symptom sheet 12. How good was the information in the Post-Op Advice leaflet in preparing you for any post operative issues? Average Score 1.2 Previous years: 1.1, 1.3 16. Overall please rate your overall satisfaction with our service Average Score 1.7 Previous years: 1.1, 1.2

Audit results – Post-Op Questionnaire #2 13. How have your symptoms responded to surgery? Cured 48% Previous years %: 50, 42 Greatly Improved 43% Previous years%: 35, 42 Slightly Improved 7% Previous years %: 11, 11 No Change 2% Previous years %: 4, 4 Worse <1% Previous years %: 0, 2 14. Did you require any ANTIBIOTICS resulting from your Operation? Average of 1% of patients needed antibiotics Previous years %: 3.4, 2.2 31% of antibiotics were given by the Hand Surgeon Previous years %: 42, 29

Audit results 15. Did you have to seek any medical advice (urgent or routine) for any reasons other than an infection? Only 1 complication listed Lumps due to scarring: Cedar HealthCare - is anyone's from there to explain more?

2019 – CTS audit collection It’s not too late to start using the Audit tool to start collecting for this years audit that runs from 1st January 2019 until 31st December 2019 I’ll collect next year to present at the 2020 conference Email me and I’ll send you all the bumpf you need to set it up Collect the data whilst you go along – as I have now set up an Excel sheet that will do all the work for you and even will fill out your return audit sheet for you – all you’ll need then is transpose your completed audit sheets figures into a SurveyMonkey weblink

2019 Onwards Audit Changes Q15. was expanded from: Did you have to seek any medical advice (urgent or routine) for any reasons other than an infection? Into Q15a. Did you have to seek any medical advice from your Hand Surgery team or your GP (urgent or routine) for any reasons other than an infection? Q15b. Did any complication following your hand surgery require you see a Consultant at a Hospital? If Yes to either of these questions please inform us why, and what treatment you received from them? PLUS new marking score……

2019 Onwards Audit Changes The scoring system has also changed, so don’t use your 2018 question sheets!!!!! I have changed this year’s scoring system, so ‘EXCELLENT’ equals now a score of 7 & not 1 (as last 2 years) , with ‘Very Poor’ accordingly now being scored as 1 Therefore your average scores should now be close to 7 - the higher the better The PEM had the highest score for a worse condition, so I originally copied that idea for the rest of the scoring. But a few surgeons suggested that getting a higher score was a better way of showing outcomes than trying to obtain a low average score. In fact 2 of the 8 practices in this years audit scored it the new way a year early! I have adapted the automatic score sheet for 2019 to reflect this, so again don’t use anything prior to 2019

External Factors 1. BSSH: Not sure what they’ve done re their audit plans– Hopefully Ian can inform us? 2. Publish: As we have a large body of data I will try to get it published this year. If anyone can help me please find or email me!! Gtbvas@yahoo.co.uk 3. Matthew Gardiner: Plastic and hand surgeon in Oxford:   I am part of a Anglo-Dutch group of researchers investigating the treatment of trigger finger (http://reconstructivesurgerytrials.net/trigger). Would the ASPC be interested in collaborating on a research project around how your members treat the trigger finger? If you are please leave your name on the sheet at the front - thanks