Evaluating the use of Getting It right first time GIRFT guidelines in suspected Cauda Equina Syndrome CES at a London District General Hospital DGH

Background Cauda equina syndrome (CES) is a relatively rare condition caused by compression of the lower part of the spinal cord. Identifying CES early and taking prompt action is essential for a better outcome. A delay in diagnosis and treatment can have serious consequences, potentially leading to permanent disability. In some cases, this delay may even result in legal action being taken. Aim The aim of this quality improvement project (QIP) is to find areas to improve in diagnosing Cauda equina syndrome and update our guidelines according to Get It Right First Time (GIRFT). Methods and results The study, conducted in accordance with GIRFT recommendations, employed a retrospective design and focused on patients admitted to the DGH A&E department with suspected CES. Initially, a cohort of 37 patients with 8 (21.6%) being male and 29 (78.4%) being female, was screened over a six-month period from January to June 2023. Patients admitted without CES as a differential diagnosis in the Emergency Department were excluded, while those admitted with suspected CES were included. Data, including neurological examinations, post-void scans, perianal sensation examinations, MRI request and completion times, and hospital stays, were analysed and presented at a T&O mortality and morbidity meeting. 89.19% of MRI scans were completed within 24 hours of being ordered and 10.81% of MRI scans took longer than 24 hours from the time of request. 57% of patients admitted did not have a thorough neurological examination performed and this was improved in our final cycle once our proforma submitted. Conclusion This quality improvement initiative identified delays in conducting comprehensive neurological examinations and limited accessibility to MRI for diagnosing CES. Our team took direct action by engaging with the Emergency Department and radiology services. As a result, implementing our CES proforma to T&O ensured timely diagnosis by facilitating all necessary examinations upon admission for patients suspected of having CES.