Aims and Objectives Cauda Equina Syndrome (CES) is a neurosurgical emergency that requires urgent assessment and intervention. GIRFT recommendations suggest MRI scanning should be available 24/7 but our ED had limited access in hours and only 2 slots at weekends.

AIM: To increase the availability and earlier access to MRI for patients with suspected cauda equina syndrome.

Method and Design The ED and radiology departments collaborated to develop an MRI direct to scan (DTS) pathway bypassing radiology discussions. Using GIRFT recommendations, specific criteria were selected to ensure robust governance around patient selection with senior ED review. If any alternative diagnosis was considered an extended scan was required and pathway unsuitable. A limited T2 weighted imaging protocol was used reducing scan times to 5 minutes. The pathway was implemented in January 2023 and comparisons made with 4 weekly average data taken from June to December 2019.

Results and Conclusion Since DTS was implemented, 167 patients have required MRI lumbar scans with 71 benefiting from the protocol (48%) The project increased radiology capacity for MRI by 155%. All DTS scans had documented senior review at radiology request to ensure governance. The pathway has reduced average waiting times for MRI scan in hours by 46% and in OOH period by 58%.There has been an increase in number of positive cases from 4.2% to 6.5%. The number of hospital admissions and inter-hospital transfers has reduced by 50%.

The DTS protocol has significantly reduced patient waiting times allowing earlier diagnosis of CES. Increased accessibility has improved both ED and inpatient bed access. The increased number of positive cases demonstrates robust governance of scans requested. Further work is required to reduce time from presentation to request with more robust triage and earlier senior review. There needs to be regional discussions to ensure recommended 24/7 MRI imaging is available and reduce delays in the OOH period further.