Luton cauda equina syndrome pathway: a pragmatic approach to achieve a national target of time to scan in UK district general hospitals

Listen to Amy and Simon discuss the paper 'Luton cauda equina syndrome pathway: a pragmatic approach to achieve a national target of time to scan in UK district general hospitals' published in the February 2026 issue of Bone & Joint Open.

Click here to read the paper.

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Transcript

[00:00:00] Welcome back to another episode of AI Talks with Bone & Joint from the publishers of Bone & Joint Open. Today we're discussing the paper, 'Luton cauda equina syndrome pathway: a pragmatic approach to achieve a national target of time to scan in UK district general hospitals', published in February 2026 by A Naik and colleagues. I'm Simon, and I'm joined by my co-host Amy.

Hello everyone, we have a rather fascinating discussion lined up for today. Cauda equina syndrome is a rare but serious condition necessitating immediate medical attention. Simon, might you provide us with a brief overview of cauda equina syndrome or CES.

Of course, Amy. CES occurs when there is an acute compression of the lumbar and sacral nerve roots. This can result in severe symptoms including bilateral sciatica, bladder and bowel dysfunction, reduced peroneal sensation, and significant muscle weakness in the lower limbs. Timely diagnosis and treatment are critical, often involving emergency spinal decompression.

Exactly. The key to managing [00:01:00] CES effectively is obtaining an MRI scan as swiftly as possible once symptoms arise. The paper we are discussing today examines a pathway implemented at Luton and Dunstable University Hospital aimed at improving the time it takes to obtain an MRI scan for patients suspected of having CES.

Their objective was to meet a national target of under four hours from MRI request to the actual scan. Indeed, before we delve into the methods and results, let's consider why this research was undertaken. The national CES pathway from the Getting It Right First Time initiative highlighted the need for 24/7 MRI services at district general hospitals across the UK. However, many of these hospitals face challenges with limited MRI scanning capacity, particularly outside regular hours.

A Clinical Imaging Board report revealed that the UK had one of the lowest MRI availability rates among OECD countries with only 6.1 MRI systems per million population. A survey of 234 trusts indicated that nearly [00:02:00] 14% had 24/7 MRI access mostly in large teaching hospitals. This led to suboptimal management of CES and significant delays in obtaining MRI scans.

So, the Luton CES pathway was introduced in 2021 to address this issue head on. The pathway, leveraged the existing in-hours MRI service available from 7:00 AM to 6:00 PM, to streamline the diagnosis and treatment process for suspected CES cases. Their goal was to reduce the median time to scan and minimize the need for out-of-hours transfers to tertiary centres for urgent MRI scans.

The research involved a retrospective review of patients presenting with suspected CES before and after the pathways introduction. They compared data from 2018 and 2024 to evaluate the pathway's effectiveness. The primary outcome measure was the time to scan while secondary outcomes included the number of patients scanned, the scan positive rate, and the number of out-of-hours transfers.

To discuss the findings, they observed that the median time [00:03:00] to scan improved from 8 hours 48 minutes in 2018 to merely 34 minutes in 2024. This represents a significant reduction. Moreover, the number of patients scanned more than doubled from 280 to 688. Most notably, the proportion of patients meeting the national target of under four hours to scan increased from 66% to nearly 90%.

Those are impressive numbers. The pathway evidently made a substantial difference. Another intriguing result was the reduction in the number of patients needing out-of-hours transfers, which dropped by more than 50% from 17 to 6. This not only alleviated pressure on tertiary centres, but also saved valuable resources such as ambulance transfers and hospital beds.

Absolutely. The study underscored that a local dedicated pathway can achieve national targets using the existing in-hours MRI service available in every district general hospital. Until hospitals can establish a comprehensive 24/7 MRI service, this [00:04:00] pragmatic approach appears to be an effective interim solution.

One of the key takeaways from the study is the application of nudge theory, which the authors utilized to enhance the process. By creating a pathway that provided clear steps for urgent MRI requests and eliminated unnecessary approvals they effectively nudged healthcare providers to adhere to best practices in a streamlined manner.

Precisely. The pathway included reserved MRI slots specifically for suspected CES cases, preventing the need to reschedule other appointments and ensuring swift access to MRI scans. This approach could be extrapolated to other district hospitals facing similar challenges.

In summary, the Luton CES pathway illustrates how local initiatives can have a significant impact using existing resources. By optimizing in-hours MRI availability, this approach drastically reduced the time to scan, increase the number of patients served, and minimize the need for costly out-of-hours interventions.

It's evident that [00:05:00] practical solutions like these can bridge the gap until more comprehensive 24/7 MRI services become standard across all hospitals. For our listeners involved in healthcare policy or hospital administration, this paper provides a valuable blueprint for improving patient outcomes in an economically efficient manner.

Indeed. Well, that brings our discussion to a close for today. Don't forget to check out the full paper for more detailed insights and stay tuned for our next episode. Thanks for listening. See you next time on AI Talks with Bone & Joint.