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Getting it right first time for spinal injury patients

In February 2019, the GIRFT (“Getting It Right First Time””) programme, a national programme designed to improve the quality of care within the NHS, published its national report on spinal surgery. The report seeks to address the variations in the standards of care afforded to patients throughout the country, with the ultimate aim of identifying how care can be improved.

Of note, the report contains an analysis of the care currently being provided to patients presenting with suspected cauda equina syndrome, as well deficiencies in that care.

Some of the key recommendations from the report include the proposal that patients with suspected cauda equina syndrome have access to emergency MRI scanning and that this must be undertaken at the patient’s local hospital, and that the scan must take precedence over routine cases. It also recommended that reasons for a delay or decision not to perform an emergency scan should be clearly documented.

The report also recommends adherence to the existing recommendations in respect of assessing patients with suspected cauda equina syndrome from the Society of British Neurological Surgeons (“SBNS”) and the British Association of Spinal Surgeons (“BASS”).

The report notes that a recent national audit of treatment and investigation of cauda equina syndrome found that the SBNS/BASS standards were not currently being met, with potentially life changing consequences for patients. The study found that there were difficulties in how out-of-hours services were organised, and that evidence collected during the report authors’ visits indicated that the principle reason for patients with suspected CES not receiving timely MRI scans was a lack of out-of-hours radiography support in referring units.

The GIRFT report also found that many care providers have little knowledge of the clinical negligence claims made against them, and therefore there were repeated failures to learn from previous claims. Ultimately, the report recommended that there be “referral without delay to 24 hour MRI scanning in all hospitals for patients with suspected Cauda Equina Syndrome."

In my experience as a solicitor specialising in spinal injuries caused by clinical negligence, delays in diagnosing cauda equina syndrome can have catastrophic consequences for patients, leaving them with significant injuries which can include loss of mobility, permanent loss of bladder or bowel function and severe neuropathic pain. It is hoped that the GIRFT report will contribute to improving standards of care for those who present to hospital with suspected cauda equina syndrome.

 

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