A new pathway and case study supporting providers to tackle the elective backlog by carrying out more hand and wrist surgery using an anaesthetic block rather than general anaesthetic are now available from the GIRFT team.
Based on an innovative pilot at Wrightington Upper Limb Unit – part of the Wrightington, Wigan and Leigh (WWL) Teaching Hospitals NHS Foundation Trust – the block-only hand and wrist surgery pathway covers each stage of the patient journey, from recommended selection criteria through to discharge and follow-up.
WWL introduced the high-volume, high-complexity, block only pathway in 2025, as an innovative solution to tackle the elective backlog. GIRFT’s new case study outlines how the structured, consultant-led standard operating procedure has streamlined the pathway and reduced waiting times for patients.
For example, from September to November 2025, 51 patients at the Wrightington Upper Limb Unit underwent upper limb surgery under regional anaesthesia; 29 via the block only pathway, 22 via the traditional general anaesthetic (GA) pathway. Mean waiting times to surgery reduced from 190 days to 135 days in the block only cohort, with zero conversions to GA and only one unplanned admission.
Patient satisfaction was also high, with 89.5% rating their care as 10/10.
Sumedh Talwalkar, a hand and wrist consultant at WWL, said:
“I’m delighted with the outcome of this revolutionary project. Not only is it helping patients by streamlining patient pathways, but it’s also saving the trust money.”
