1279 Compliance of Countess of Chester Hospital with the Getting It Right First Time (GIRFT) Guidance on Cauda Equina Syndrome

Abstract Aim Ensure timely investigations for suspected Cauda Equina Syndrome (CES) at the Countess of Chester Hospital align with GIRFT's National Suspected CES Pathway (February 2023). Method Retrospective audit collecting data on A&E attendances with a referred suspected cauda equina syndrome between 01/09/2022 and 31/01/2023 (pre-GIRFT guidance). 36 patients were collected and narrowed down to 27 following adherences to inclusion criteria (incl. exclusion of medical inpatients with symptoms of CES who had scans done during their stay). Data collection parameters included: 1 Time of presenting to A&E. 2 Significant neurological deficit / red flags of CES on exam. 3 Time and amount on post-void bladder scan. 4 Time of MRI request. 5 Time of MRI completion. 6 Confirmed CES on scan. 7 Transfer and further management in neurosurgery centre. Results Of 26 admissions (one was transferred to regional neurosurgical centre before local review), 21 showed CES signs. Mean time from MRI request to completion was 4.67 days. Only six had timely MRI completion within 4 hours, with nine patients confirming CES. Six patients were transferred to the neurosurgical centre. Conclusions Significant MRI delays, some over 24 hours, stem from A&E challenges such as understaffing and prolonged wait times. Delays occur when the neurosurgical centre advises next-day scans. Recommendations include radiology adherence to GIRFT guidance and discussing introducing additional dedicated MSK radiologists and collaborating with A&E to streamline reviews for suspected CES. Thorough documentation is emphasised. Further review is recommended post-implementation to assess improvements in compliance with MRI requesting and scan completion timelines.