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

<ns3:p>Background Cauda equina syndrome (CES) is a rare but serious condition caused by compression of the lower spinal cord. Early recognition and prompt intervention are essential to prevent irreversible neurological damage. Delays in diagnosis or treatment can lead to permanent disability and may result in significant medicolegal consequences. Aim The aim of this quality improvement project (QIP) was to identify areas for improvement in the diagnosis of CES and update local guidelines in line with the Get It Right First Time (GIRFT) recommendations. Methods and Results This retrospective study, conducted according to GIRFT guidelines, examined patients admitted to the District General Hospital Emergency Department with suspected CES. A total of 37 patients—8 males (21.6%) and 29 females (78.4%)—were assessed over a six-month period from January to June 2023. Patients without CES listed as a differential diagnosis were excluded. Data collected included documentation of neurological examinations, post-void residual scans, perianal sensation assessments, MRI request and completion times, and length of stay. Findings were presented at the Trauma and Orthopedics mortality and morbidity meeting. Overall, 89.19% of MRI scans were completed within 24 hours of request, while 10.81% exceeded this timeframe. Notably, 57% of patients did not undergo a comprehensive neurological examination on admission. Following these findings, a CES proforma was introduced to standardize the assessment process. In the subsequent cycle, documentation improved significantly, demonstrating the effectiveness of the intervention. Conclusion This QIP highlighted key areas requiring improvement, particularly the inconsistent completion of neurological examinations and delays in MRI access for suspected CES cases. Collaboration with the Emergency Department and radiology services led to the implementation of a CES assessment proforma, ensuring timely and consistent evaluation of patients. This structured approach supports earlier diagnosis, aligns with GIRFT standards, and enhances the quality and safety of CES management within our hospital.</ns3:p>