1. Dr Gareth James ASPC Audit lead
Carpal Tunnel Audit
Dr Gareth James
ASPC Audit lead

2. 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

3. At last years conference
The ASPC has decided to use the
PEM hand tools
The Hand Health Questions – just part 2
Parts 1 and 3 of the PEM have their questions deemed inadequate, and alternatives added

4. CTS QUESTIONNAIRE ONE - CTS PRE-OP
Essentially this is just the 11 question PEM (part 2) - sent to the patient at the same time as their appointment details/information leaflet, and for the patients to bring it completed on the day of their operation.
We also decided that the PEM questionnaire should NOT be routinely used for diagnostic purposes

5. CTS PRE-OP PEM Part 2 The Hand Health Questions

6. CTS QUESTIONNAIRE 2 - CTS IMMEDIATE POST-OP
To be filled on the day, straight after the operation.
There are only 5 questions here, including the ‘Friends and Family’ Q.
As per government directive: you should be asking the F&F question on the day anyway.

7. CTS IMMEDIATE POST-OP

8. 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 (part 2) to fill out again
The difference from the first pre-op total, to the total post op will be our VALIDATED total
Plus there another 5 questions, these will be THE MAIN BASIS OF YOUR KNOWLEDGE OF YOUR COMPLICATIONS
This also includes as the most specific question –
17. How have your symptoms responded to surgery?

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

10. CTS POST-OP Questionnaire Page 2

11. How to Score - the PEM Post Op Difference (PEM PoD)
Patients name, or identity number needs to be on both Pre and Post questionnaires.
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).
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).
Subtract the Post-Op score from the Pre-Op score for each patient = their PEM PoD
Patients with a minus or static PEM PoD score obviously have not done well, nor has a patient with  any severity still scoring 7.
These patients need review - 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.
The Audit be asks for your AVERAGE PEM PoD Score for all your patients

12. How to Score Q2 – CTS IMMEDIATE POST-OP
For the other questions I will be asking the average score per question:-
1. How good was the information leaflet sent to you prior to your appointment to prepare you for today’s operation?
2. How did you rate the Doctor's manner and communication during the operation?
3. What was your overall impression of having your Carpal Tunnel Operation undertaken here at this Clinic?
But I will only the percentage achieved for ‘Very Likely’ to
4. How likely are you to recommend our clinic to friends or family if they needed similar care or treatment?

13. How to Score 3 – CTS POST-OP Page 2
I will be asking the average score to both:-
12. How good was the information in the Post-Op Advice leaflet in preparing you for any post operative issues?
16. Overall please rate your overall satisfaction with our service
The percentage and number for EACH of the 5 choices relating to
13. How have your symptoms responded to surgery?
The percentage of those who required antibiotics post-operation, and of those what percentage were given by the CTS surgeon in Q14
I will ask also ask what replies you received from the question:
15. Did you have to seek any medical advice (urgent or routine) for any reasons other than an infection?

14. Audit cycle timeframe
The audit cycle should be 12 months covering the periods 1st Jan until 31st Dec
Collection of that year’s data for the following Conference presentation
So this audit cycle has been running since September going on up to 31st December 2016.
The 2017 audit cycle started 1st Jan until 31st Dec 2017.
Data from 2017 to be collected and presented at the conference

15. Audit results
Sadly I only had data from 4 practices. This accounted for some 759 CTS operations It’s a start, but come on folks lets get more in next year!!! What percentage Returns rates are you getting? Pre-op: Average 81%. 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 79% Again why not higher, they cant leave the building until its done! Post op: Average 46% Not that bad actually! You can just get someone to phone them and do the form…. The average PEM PoD score was 21

16. Audit results – On the day Questionnaire
Average scores for the below questions: rated 1 (excellent) to 7 (poor)
How good was the information leaflet sent to you prior to your appointment to prepare you for today’s operation?
Average Score 1.1
2. How did you rate the Doctor's manner and communication during the operation?
Average Score 1.0
3. What was your overall impression of having your Carpal Tunnel Operation undertaken here at this Clinic?
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%

17. 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 Overall please rate your overall satisfaction with our service (Please circle)

18. Audit results – Post-Op Questionnaire #2
13. How have your symptoms responded to surgery?
Cured 50%
Greatly Improved 35%
Slightly Improved 11%
No Change 4%
Worse 0%
14. Did you require any ANTIBIOTICS resulting from your Operation?
Average of 3.4% of patients needed antibiotics
42% of antibiotics were given by the Surgeon
1 Patient self prescribed and took a stock of her husbands!

19. Audit results
15. Did you have to seek any medical advice (urgent or routine) for any reasons other than an infection? A Patient who was given a guarded prognosis due to having CTS for many, many, years returned to their GP (and also saw a Physio) requesting further medical advice as they were still experiencing some symptoms. 1 case of tender scar, pilar pain, pain in other parts of hand and arm 1 case of post operative haematoma

20. 2017 – 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 2017 until 31st December 2017.
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!