Background Early detection of malignant spinal cord compression (MSCC) is essential to minimise the severe consequences arising from this condition (Macdonald, Lynch, Garbett et al., 2019. JR Coll. Physicians Edinb. 49:151). Unfortunately, a patient in the community with neurological signs of MSCC did not get a spinal MRI done for several days. We therefore suspected that the local MSCC pathway was unclear and not well understood.
Aim Our aim was to prevent other patients having a delay in getting a spinal MRI by understanding and improving the MSCC pathway; and developing and delivering education about the new pathway to multi-professional clinical teams at Dorothy House Hospice and the Royal United Hospitals, Bath NHS Foundation Trust (RUH).
Method A team from Dorothy House Hospice and the RUH delivered questionnaire surveys to clinicians in both settings involved in the care of patients with suspected spinal cord compression. Questions sought to identify the strengths and weaknesses of the current MSCC pathway.
Results Survey responses were received from N=46 medics, therapists, and nursing staff (Dorothy House n=39, RUH n=7). Using a 10-point numerical rating scale (0=not at all confident, 10=extremely confident), 80% of hospice clinicians reported confidence in recognising potential MSCC (rating ≥7); 77% reported confidence in knowing what to do (rating ≥7). However, a variety of subsequent actions was identified, and methods for recording suspected MSCC were not always consistent. RUH clinicians reported MSCC pathways in the community were unclear and responses highlighted variability in the timing of MRI scans following referrals from the hospice. Findings have informed the re-design of the MSCC to make it clearer, more concise and with well-defined responsibilities. Teaching to nursing staff is underway.
Conclusion MSCC pathways in community care can be ambiguous and sub-optimal. Understanding clinicians’ perceptions locally has enabled the development of a clearer pathway for implementation within the hospice. Evaluation of its impact is planned.
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