TY - JOUR
T1 - A novel approach to expedite emergency investigation for suspected cauda equina syndrome referrals from community and primary care services
T2 - A service evaluation
AU - Gill, Jonathon
AU - Greenhalgh, Sue
AU - Latour, Jos M.
AU - Pickup, Stephen
AU - Yeowell, Gillian
N1 - Publisher Copyright:
© 2024 Elsevier Ltd
PY - 2024/8
Y1 - 2024/8
N2 - 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.
AB - 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.
KW - Cauda equina syndrome
KW - Clinical pathway
KW - Red flags
UR - http://www.scopus.com/inward/record.url?scp=85193236680&partnerID=8YFLogxK
U2 - 10.1016/j.msksp.2024.102976
DO - 10.1016/j.msksp.2024.102976
M3 - Article
AN - SCOPUS:85193236680
SN - 2468-8630
VL - 72
JO - Musculoskeletal Science and Practice
JF - Musculoskeletal Science and Practice
M1 - 102976
ER -