A156: A REVIEW OF NORTH DEVON DISTRICT HOSPITAL MANAGEMENT OF METASTATIC SPINAL CORD COMPRESSION IN 2014
1North Devon District Hospital, Devon, UK
Acute oncology is growing subspecialty in which multiple pathways are under development, constant reviews have to be done in order to ensure compliance with NICE guidelines.
Due to the poor life expectancy of patients with MSCC, prompt treatment should be sought to reduce morbidity e.g. incontinence. NICE guidelines have thus set about strict recommendations for treatment within 24 hours post MRI scan.
Management of patients identified with metastatic spinal cord compression at N.D.D.H is facilitated by a pathway developed in conjunction with the acute oncology team at Royal Devon and Exeter Hospital (RD&E).
The aim of the audit was to review the local adherence to this pathway, in particular, the timeframe within which patients received MRI imaging to treatment, surgery and/or radiotherapy which should be less than 24 hours.
Multiple sources of patient information were reviewed to identify patients with the diagnosis and those who were treated. These were the medical assessment unit admissions list, patient clinic referral lists (for example oncology clinic or urology clinic), the MRI spine list, comprising 497 scans done in 2014, and the list of patients from N.D.D.H treated at RD&E with radiotherapy/surgery.
The oncology clinic and GP made up the majority of patient referrals treated for M.S.C.C. (19). There were nineteen MRI scans performed, eleven scans were positive for cord compression; eight patients had no MRI evidence of cord compression. The majority of patients were transferred the day after MRI scan (73%). The oncology clinic had the highest average wait to getting treatment after the MRI scan (194 hours) The ED route had the shortest average (26 hours). Overall survival was on average less than six months.
Although patient transfer was prompt between the two hospitals, some patient groups were not getting treatment within 24 hours post MRI.