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Updated: May 21, 2026
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Published on: July 5, 2011
Transition to total one-stop wide-awake hand surgery service-audit: a retrospective review
Msk Bismil1, Qmk Bismil, David Harding
1Parkside Surgery, Boston, Lincolnshire PE21 6PF , UK.
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.
