Expediting the management of cauda equina syndrome in the emergency department through clinical pathway design.
In: BMJ open quality, Jg. 8 (2019-11-02), Heft 4, S. e000597
Online
academicJournal
Zugriff:
Introduction: Cauda equina syndrome (CES) is a neurosurgical emergency. Early diagnosis with MRI and subsequent surgical decompression surgery can prevent permanent neurological dysfunction. Charing Cross Hospital (CXH) is a tertiary neurosurgical referral centre where in the emergency department (ED), current practice mandated a neurosurgery review prior to requesting MRI.
Hypothesis: It was hypothesised that a new clinical pathway, with better coordination from the ED, radiology and neurosurgical teams could reduce the time of presentation to diagnosis or exclusion of CES.
Method: Retrospective case-note analysis of patients presenting with back pain to CXH ED over a 3-month period was performed. The primary outcome was the time interval between the patient's arrival to the ED and the MRI preliminary report.
Results: The baseline primary outcome was recorded at 8 hours and 16 min (n=30). A new clinical pathway was designed empowering ED senior decision makers to order MRIs prior to neurosurgical review. Two Plan-Do-Study-Act (PDSA) cycles were performed, each measured over a 2-month period. The first PDSA cycle was performed after the pathway was initially launched (n=17), while the second PDSA cycle measured the effect of staff education and active promotion of the pathway (n=17). MRI was requested earlier, waiting and reporting time for MRI were reduced. The exclusion or diagnosis of CES was reduced to 5 hours and 54 min in PDSA 1 and 5 hours 17 min in PDSA 2, a 29% and 36% reduction (p=0.048 and p=0.012, respectively).
Conclusion: The clinical protocol was a cost-neutral and sustainable intervention that effectively reduced the time taken to diagnose or exclude CES and ED waiting times.
Competing Interests: Competing interests: None declared.
(© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
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Expediting the management of cauda equina syndrome in the emergency department through clinical pathway design.
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Autor/in / Beteiligte Person: | Buell, KG ; Sivasubramaniyam, S ; Sykes, M ; Zafar, K ; Bingham, L ; Mitra, A |
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Zeitschrift: | BMJ open quality, Jg. 8 (2019-11-02), Heft 4, S. e000597 |
Veröffentlichung: | London : BMJ Publishing Group, 2019 |
Medientyp: | academicJournal |
ISSN: | 2399-6641 (electronic) |
DOI: | 10.1136/bmjoq-2018-000597 |
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