A novel approach to expedite emergency investigation for suspected cauda equina syndrome referrals from community and primary care services: A service evaluation.
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Authors
Gill, Jonathon
Greenhalgh, Sue
Latour, Jos M.
Pickup, Stephen
Yeowell, Gillian
Issue Date
2024-05-14
Type
Journal Article
Language
en
Keywords
Wessex Classification Subject Headings::Diseases & disorders of systemic, metabolic or environmental origin::Emergency medicine , Wessex Classification Subject Headings::Patients. Primary care. Medical profession. Forensic medicine
Alternative Title
Abstract
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. To compare the outcomes of patients referred via an original and redesigned Community and Primary Care CES pathway. A retrospective service evaluation was undertaken of all emergency MRI scans investigating suspected CES via either pathway. 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. 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%. 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.
Description
Citation
Gill, J.; Greenhalgh, S.; Latour, JM.; Pickup, S. and 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 & Pracitce, Available at: https://doi.org/10.1016/j.msksp.2024.102976
Publisher
Elsevier
License
Copyright © 2024 Elsevier Ltd. All rights reserved.
Journal
Musculoskeletal science & practice
Volume
72
Issue
PubMed ID
ISSN
2468-7812