A novel approach to expedite emergency investigation for suspected cauda equina syndrome referrals from community and primary care services: A service evaluation.
Musculoskelet Sci Pract
; 72: 102976, 2024 08.
Article
em En
| MEDLINE
| ID: mdl-38768530
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 3h01m to 1h02m; reduction in time spent in ED 4h55m to 3h24m; reduction in time to surgery 18h05m to 13h38m; 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.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Atenção Primária à Saúde
/
Encaminhamento e Consulta
/
Imageamento por Ressonância Magnética
/
Síndrome da Cauda Equina
Limite:
Adult
/
Aged
/
Female
/
Humans
/
Male
/
Middle aged
País/Região como assunto:
Europa
Idioma:
En
Ano de publicação:
2024
Tipo de documento:
Article