A Novel Approach to Expedite Emergency Investigation for Suspected Cauda Equina Syndrome Referrals from Community and Primary Care Services: A Service Evaluation

IntroductionAlthough 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.ObjectiveTo compare the outcomes of patients referred via an original and redesigned Community and Primary Care CES pathway.DesignA retrospective service evaluation was undertaken of all emergency MRI scans investigating suspected CES via either pathway.MethodsTwo 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.ResultsIncreased 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%.ConclusionAll 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.