349 Improving Assessment of Patients with Suspected Cauda Equina Syndrome Using A Standardised Proforma

Abstract

Abstract Introduction Cauda Equina Syndrome (CES) has a devastating impact on the life of affected individuals. Most patients are reviewed by doctors who do not have specialist spinal expertise. NHS Lanarkshire guidelines for CES are based on ‘Standards of Care in Cauda Equina Syndrome’ (Todd and Dickson) 2016. Method Documented assessment of a sample of patients with suspected CES in our hospital was audited against standards set in regional guidelines. A tick-box proforma was introduced to standardise assessment, with re-audit thereafter. Chi-squared was used for statistical analysis. Results Cycle 1 (2018): Documented assessment of findings in 30 patients - bilateral radiculopathy (80%), urinary incontinence (93%), faecal incontinence (73%), anal tone (93%), saddle anaesthesia (83%), bladder volumes (90%) and ASIA chart (20%). Cycle 2 (2019): Documented assessment of above findings was 100% in patients where a proforma was used. Proforma was used in 81% of patients. Conclusions Use of a standardised proforma improved assessment of CES. There was a statistically significant improvement in use of an ASIA chart (P < 0.01) and assessment of faecal incontinence (P = 0.039). Compliance with use of this proforma could be improved further, to enhance patient care. Following the success of the proforma, it is being reviewed for implementation on a regional level.