The Southampton Dupuytren's Clinic: audit of an effective multidisciplinary model

Abstract

Introduction

The Southampton Dupuytren's Clinic (SDC) was preceded by a four-month period when the therapist accompanied the surgeon in Clinic to learn about Dupuytren's Disease (DD) and to develop a specific proforma to collect details of the patient, the condition and the planned treatment.

Methods

A special clinic was set up for general practitioner referrals for patients with DD. Each patient was seen by the therapist. A detailed history and examination were recorded on the proforma. Treatment options to include the outcome, risks and benefits of surgery were clearly explained, supported by a handout. The patient was then seen by the surgeon to arrange management.

Results

One hundred and ninety-four patients were allocated to the SDC. In all, 5% failed to attend; 8% had an alternative diagnosis made; and 16% with DD were discharged as the disease was not advanced enough for intervention or the patient decided not to have surgery. The therapist then allocated 71% for surgical assessment. The surgeon, to efficiently allocate personnel and theatre resources, listed 22% for skin graft, 8% for fasciotomy, 70% for fasciectomy, 35% for consultant to perform, 35% for fellow/registrar to perform, and 30% for the consultant to train the registrar.

Conclusions

We consider that triage and assessment of patients with DD is improved by a multidisciplinary approach: a hand therapist, to quantify deformity and functional deficit, and explain the purpose, risks and outcome of surgery; and a hand surgeon, to decide the type and duration of surgery and the appropriate grade of surgeon.