Transition to total one-stop wide-awake hand surgery service-audit: a retrospective review

OBJECTIVES: To document the transition to a totally one-stop (patient seen and treated in one appointment) wide-awake (local anaesthesia only) hand surgery service. DESIGN: Retrospective review of 10 year service with detailed analysis of last 1000 cases including process and cost-effectiveness and efficiency analysis. SETTING: Purpose-built CQC-certified day-case surgical facility where we have pioneered the UK's first totally one-stop wide-awake orthopaedic service. PARTICIPANTS: Approximately five thousand orthopaedic patients treated in the last ten years. MAIN OUTCOME MEASURES: Surgical outcomes, patient satisfaction and cost-effectiveness and efficiency. RESULTS: The OSWA model is safe, efficient and effective; with a low complication rate, extremely high patient satisfaction; and cost-savings to the NHS of 50–75% of the national tariff. The service saved the NHS approximately £750,000 for the 1000 cases presented; and over £2 million since the inception of the service. CONCLUSIONS: A totally one-stop wide-awake hand surgery service is a practicable and feasible alternative to the conventional treatment pathway with benefits in terms of efficiency and cost-effectiveness.