A novel approach to expedite emergency investigation for suspected cauda equina syndrome referrals from community and primary care services: A service evaluation
ORCID
- Jos M. Latour: 0000-0002-8087-6461
Abstract
Introduction: Although a rare spinal emergency, cauda equina syndrome (CES) can result in significant physical, emotional, and psychological sequalae. Introducing a CES pathway enhances diagnosis but may increase Radiology and Orthopaedic workload. To address this, one NHS hospital in England introduced a novel CES pathway. Utilising a criteria-led pathway, patients were referred directly from community/primary care, via the Emergency Department, for an emergency MRI scan. Objective: To compare the outcomes of patients referred via an original and redesigned Community and Primary Care CES pathway. Design: A retrospective service evaluation was undertaken of all emergency MRI scans investigating suspected CES via either pathway. Methods: Two 3-month time periods were analysed; pre-(original) and post-implementation of the redesigned pathway; time to surgery was reviewed over two 12-month periods. Results: Increased MRI scan utilisation was seen following the implementation of the redesigned pathway: original n = 50, redesigned n = 128, increasing Radiology workload. However, the redesigned pathway resulted in a reduction in time to MRI from 3h:01m to 1h:02m; reduction in time spent in ED 4h:55m to 3h:24m; reduction in time to surgery 18h:05m to 13h:38m; reduction in out-of-hour scanning from 10 to 2 patients during the evaluation period; and a reduction in on-call Orthopaedic involvement by 38%. Conclusion: All timed outcomes were improved with the implementation of this novel pathway. This suggests expediting MRI scans can result in substantial downstream benefits; albeit while increasing MRI scan utilisation. This pathway aligns with the emergency management of suspected CES under the new national CES pathway in England.
DOI
10.1016/j.msksp.2024.102976
Publication Date
2024-01-01
Publication Title
Musculoskeletal Science and Practice
Volume
72
ISSN
2468-8630
Embargo Period
2025-05-14
Keywords
Cauda equina syndrome, Clinical pathway, Red flags
Recommended Citation
Gill, J., Greenhalgh, S., Latour, J., Pickup, S., & Yeowell, G. (2024) 'A novel approach to expedite emergency investigation for suspected cauda equina syndrome referrals from community and primary care services: A service evaluation', Musculoskeletal Science and Practice, 72. Available at: https://doi.org/10.1016/j.msksp.2024.102976
