Evidence that using GIRFT’s national pathway and guidance in cases of suspected cauda equina syndrome (CES) can result in fewer patients admitted to hospital has been published in a peer-reviewed academic journal.
The independent study, by a team from Northern Care Alliance NHS Foundation Trust (Sai Viswan Thiagarajah, Edward Cornish, Amit Kapoor, Jeremy Telford, Thomas Langstroth and Kenneth Koo), has been published in the Neuroradiology Journal and is the first to evaluate the effect of implementing the GIRFT guidance.
The authors conclude that utilising the CES pathway and guidance can reduce CES related service pressures without impacting diagnosis, highlighting the value of the GIRFT resources for neurosurgical and orthopaedic departments across England.
CES is a spinal surgical emergency which can lead to lower limb paralysis and loss of bowel, bladder and sexual function if not assessed and treated urgently. The condition affects 1-3 people per 100,000 population in England and there are around 8,000 suspected cases every year.
Red flag symptoms
The GIRFT team worked collaboratively with a multidisciplinary group of more than 60 health professionals to develop the national pathway and guidance, supporting clinicians to diagnose without delay and care for patients suspected of having the condition.
The pathway highlights red flag symptoms and symptom duration requiring emergency MRI, offering best practice along all stages of the patient pathway, from presentation to their GP or in the community, to presentation at hospital and diagnosis, to surgery and on to post-operative care. It is supported by detailed guidance for suspected Cauda Equina Syndrome, outlining when and how to carry out stages of the pathway, including best practice for referrals and imaging, surgical techniques, pain control and other post-operative support.
The team from NCA have been using the framework in their orthopaedic service. Their study reviewed all emergency MRI scans to exclude CES during two six-month periods – one before the GIRFT guidance (175 scans) and the other after a year of using the guidance (159 scans).
Fall in admissions
After implementation of the guidance, the percentage of patients requiring admission fell from 57% to 43%, while the percentage of patients scanned on the day of presentation increased from 53% to 62%. There was no change in the percentage of scans identifying CES (4%).
The study highlights that reducing admissions by 21 patients over six months (as in their hospital) has the potential for efficiencies of £24,612 annually, presuming patients without CES are discharged on the day of scanning.
Mike Hutton, GIRFT’s clinical lead for spinal services, led the group developing the pathway.
He said: “We are delighted – but not surprised – to see the results and conclusions of this research, showing that implementing the GIRFT pathway and guidance are effective in helping to ensure same-day MRI scanning of patients who may have this devastating condition, and therefore reducing hospital admissions. We have always believed that this pathway could be highly effective in reducing patient harm and this evidence supports that. ”
- Pictured are Sai Viswan Thiagarajah and Kenneth Koo.