Lightbulb innovation: nurse-led carpal tunnel service

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Keyhole surgery may not be something you immediately associate with a nurse, but that is exactly what Louize Ainsworth performs in the highly innovative Nurse Led Carpal Tunnel Service she and her team have developed over the past ten years at NHS Stockport.

Carpal tunnel syndrome is a fairly common condition that causes pain and numbness in your fingers. In most cases, the symptoms are mild, and non-surgical treatments suffice. In severe cases however, the symptoms are debilitating to the patient and requires surgery. Luckily, the surgery itself is relatively simple, needing only a local anaesthetic and no overnight stay in hospital.
 
The irony is that carpal tunnel surgery often appears at the end of surgery lists, and is one of the first to get bumped when operating schedules overrun. It was Louize's personal experience of this, as a surgeon's assistant, that motivated her in the first place to develop a nurse-led carpal tunnel service.
 
"Telling a patient, who has endured months, maybe even years of pain, that their planned surgery needed to be re-scheduled was a horrid thing to do" recalls Louize. "And it was never, 'come back tomorrow'; it was always, 'we'll see if we have another appointment next month'"
 
Louize undertook the surgical training, with the full support of her employer, and medical consultant supervisor, and is now able to offer a seamless service to her patients, from assessment (in this case, electromyogram (EGM)), to admission, to local anaesthetic and surgery, to discharge. The service is tailored around individualised patient need; the surgery takes place at the most convenient time for the patient, when it fits in with their work, family arrangements and other commitments. There is also a much reduced waiting time from diagnosis to surgery. Patients enjoy the service and have come from as far afield as Wales to receive care/treatment. There is good word-of-mouth publicity from patient, family, friends and colleagues.
 
The all important cost savings are there too. Hospital audit data confirms that the tariff price for a medical consultant to carry out carpal tunnel surgery is £1,400 per case. The cost of the same procedure, but nurse-led (band 8b) is just £100-£200 per case. Therefore there is a cost saving of at least £1,200 on each case.
 
Finally, there is potential for dissemination of the innovation across the country, and outside of the hospital setting. "There doesn't appear to be any nurse-led carpal tunnel services like this one anywhere else in the UK" says Louise, although the evidence to increase the number of experienced registered nurses in this field would seem compelling. As a measure of her success, the nurse led carpal tunnel service is now being rolled out, via health centres, across North Staffordshire. Another first for Louize. 

Further information

If you'd like to know more about this innovation, please contact Louize Ainsworth, email: lou.ainsworth@stockport.nhs.uk.

 

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