LAUSR

Cauda equina syndrome (CES) is a spinal emergency that cannot be reliably detected through clinical examination alone and as a result requires prompt MR imaging to provide a diagnosis. This audit examined compliance to standard of care following service improvements in line with the updated SBNS/BASS national guidelines for CES. A retrospective analysis of 200 patients referred to neurosurgery for suspected CES: 100 pre- and 100 post-service improvement SBNS guideline implementation. The online neurosurgical database was reviewed, cases assessed for completeness of referral information (including appropriate exam and pre-referral MRI) with patient demographics, referring hospital and outcome also recorded. Prior to the SBNS guidelines only 19 patients received MRI prior to referral, 70% of all referrals were incomplete or contained erroneous clinical information. Post-service improvements there was a 68% increase of pre-referral MRI (32 cases), and an improvement in quality of clinical information with only 19% of referrals providing insufficient or unreliable information. Through relatively simple changes to local policy, patient care flow and education of emergency department clinicians we have significantly improved pre-referral MRI rates as well as overall referral quality across the whole DGH network.