The wait is over: Early health care delivery for acquired hand condition

Miss Kelly Briody1, Miss Zoe Milner2

1Monash Health, Clayton, Australia, 2Melbourne Health, Melbourne, Australia


To evaluate if changing a model of care reduces the waiting time for common health conditions. Acquired hand conditions referrals e.g. carpal tunnel syndrome, trigger finger and basal joint arthritis increase public health service demands. Management of these patients typically involves lengthy delays between referral and initial medical appointment. As a result, conditions worsen, limiting the viability of nonsurgical management. Positive patient outcomes are then more difficult to achieve.

Literature indicates patients with acquired hand conditions can be successfully managed by a senior hand therapist.


A clarificative evaluation was used to scope existing pathways at Monash Health (MH) and Royal Melbourne Hospital (RMH).


A change in the credentialing of senior hand therapists, to implement an advanced practice screening clinic, allowed the identification of clients appropriate for non-surgical management.

Over 15 months, 269 referrals were assessed between sites. Results of pre and post model change indicated the advanced practice role reduced the waiting time, to an average of 26 (RMH) to 55 days (MH) from beyond 6-12 months. Sixty-four patients with acquired hand conditions have been removed from public health waitlist during this time.  Plastic surgeon consultants agreed that patients reprioritised from the screening clinic, due to severe clinical presentation, required surgical intervention.

The clinic is currently continuing at MH, with ongoing funding being sought at RMH.

Significance of the findings to Allied Health:

Changing the model of care and introducing advanced practice clinicians can positively influence patient flow and positive clinical outcomes. They are sufficiently skilled to identify patients with acquired hand conditions appropriate for non-surgical management and escalate for surgical opinion.