Expediting the Management of Suspected Cauda Equina Syndrome (CES) in the Emergency Department Through Clinical Pathway Design at a District General Hospital: A Quality Improvement Project

Abstract

Background: Cauda equina syndrome (CES) is an uncommon condition that occurs due to compression of the terminal portion of the spinal cord. Early recognition and intervention in CES are crucial for an improved prognosis. Delayed diagnosis and action may lead to irreversible adverse effects, i.e., permanent disability, and in some circumstances can lead to litigation. Aim: The aim of this quality improvement project (QIP) was to identify areas for improvement and expedite the management of suspected CES patients presenting to the hospital. Material and methods: This was a retrospective study in which patients admitted to the Poole district hospital were analyzed in three groups with more than 50 patients in each subset group. The first group was audited from 1 st October 2020 to 27 th November 2020; a re-audit on the second group of patients was done from 1 st June 2021 to 16 th July 2021; the third group was re-audited from 1 st of January 2022 to 31 st of March 2022. Results: There were a total of 168 patients in all audit groups, of whom 71% were female. The mean time from getting triaged to having an MRI improved from 13hrs 54mins to 10hrs 39mins. The total inpatient length of stay (LOS) of less than 24 hours was 28% in the first cycle and improved to 54.4% by the third cycle of the audit. Eight patients exhibited a diagnosis of cauda equina syndrome (CES) and were sent to the tertiary care center. Conclusions: This quality improvement project identified delays in requesting the MRI for the diagnosis of CES and was addressed by ED booking the scans directly. This, in turn, reduced the length of stay in the hospital for patients who did not have cauda equina syndrome.

Suspected Cauda Equina Syndrome: Can the Presence of an Orthopaedic Doctor in the Emergency Department Reduce Waiting Times for MRI Scans and Inpatient Stays?

“…We believe this was due to accurate and prompt assessment, which permitted earlier MRI requests as a direct result; faster diagnosis and management. This is similar to findings in Nasim et al's paper where it was shown that the earlier the MRI scans are requested upon initial patient assessment, the shorter the inpatient stay for these patients [15].…”

Recovery with posterior decompression and dural suturing in a patient with cauda equina syndrome caused by lamina entrapment in an unstable burst fracture: A case report

“…The symptoms include lower extremity paralysis, sensory deficits in the “saddle” area, and dysfunction of bladder and bowel control. CES is typically caused by conditions that lead to acute compression of nerve roots, such as herniated discs, tumors, infections, and traumatic spinal injuries [ [1] , [2] , [3] , [4] , [5] ].…”