A novel approach to expedite emergency investigation for suspected cauda equina syndrome referrals from community and primary care services: A service evaluation.

Autor: Gill J; Spinal Surgery Service, Somerset NHS Foundation Trust, Taunton, United Kingdom. Electronic address: Jonathon.gill@somersetft.nhs.uk., Greenhalgh S; Orthopaedic Interface Service, Bolton NHS Foundation Trust, Bolton, United Kingdom; Department of Health Professions, Faculty Health and Education, Manchester Metropolitan University, Manchester, United Kingdom., Latour JM; School of Nursing, Faculty of Health, University of Plymouth, Plymouth, United Kingdom; South West Clinical School, Somerset NHS Foundation Trust, Taunton, United Kingdom., Pickup S; Spinal Surgery Service, Somerset NHS Foundation Trust, Taunton, United Kingdom; Department of Health Professions, Faculty Health and Education, Manchester Metropolitan University, Manchester, United Kingdom., Yeowell G; Department of Health Professions, Faculty Health and Education, Manchester Metropolitan University, Manchester, United Kingdom.
Jazyk: angličtina
Zdroj: Musculoskeletal science & practice [Musculoskelet Sci Pract] 2024 Aug; Vol. 72, pp. 102976. Date of Electronic Publication: 2024 May 14.
DOI: 10.1016/j.msksp.2024.102976
Abstrakt: 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.
(Copyright © 2024 Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
Externí odkaz: