Quality statement 4: Coordinating investigations for adults with suspected metastatic spinal cord compression

Quality statement

Adults with suspected metastatic spinal cord compression (MSCC) who present with neurological symptoms or signs have their diagnostic investigations coordinated by an MSCC coordinator.

Rationale

Some adults with cancer who have a high risk of developing bone metastases are at high risk of developing MSCC. When people present with suspected MSCC, it is important that diagnostic investigations are undertaken promptly. The principal role of the MSCC coordinator for adults with suspected MSCC is to liaise with healthcare professionals and ensure that investigations are organised and undertaken without delay. For those with neurological symptoms or signs it is particularly important that an MSCC coordinator is available at all times to ensure that initial management for adults with MSCC is both comprehensive and timely.

Quality measures

Structure

a) Evidence of local arrangements for identifying individuals responsible for performing the role of MSCC coordinator.

b) Evidence of local arrangements to ensure that adults with suspected MSCC who present with neurological symptoms or signs have their diagnostic investigations coordinated by an MSCC coordinator.

Data source: Local data collection. Department of Health Acute Oncology Measures 11‑3Y‑304 Manual for cancer services: acute oncology – including metatastic spinal cord compression measures (2011).

Process

Proportion of adults with suspected MSCC who present with neurological symptoms or signs who have an assessment of their requirement for, and urgency of investigations, undertaken by an MSCC coordinator.

Numerator – the number of adults in the denominator who have an assessment of their requirement for, and urgency of investigations, undertaken by an MSCC coordinator.

Denominator – the number of adults with suspected MSCC who present with neurological symptoms or signs.

Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals, and commissioners

Service providers ensure that an MSCC coordinator is available at all times to coordinate the diagnostic investigations for adults with suspected MSCC who present with neurological symptoms or signs.

Healthcare professionals ensure that adults with suspected MSCC who present with neurological symptoms or signs have their diagnostic investigations organised by the MSCC coordinator.

Commissioners ensure that they commission services that provide access to an MSCC coordinator, available at all times, to coordinate diagnostic investigations for adults with suspected MSCC who are referred from primary or secondary care.

What the quality statement means for patients, service users and carers

Adults with suspected MSCC who have neurological symptoms or signs have their tests and investigations arranged by a coordinator.

Source guidance

Definitions of terms used in this quality statement

Adults at high risk of MSCC

Adults with cancer who have, or who are at high risk of developing, bone metastases, and adults with cancer, who present with spinal pain. [Adapted from NICE clinical guideline 75 recommendation 1.3.1.1]

MSCC coordinator role

The role involves coordinating the ongoing care of adults with MSCC and the diagnostic investigations of people at risk of developing MSCC who present with relevant symptoms. An MSCC coordinator should be available 24 hours a day, 7 days a week, acting as a single point of contact for healthcare professionals to liaise with.

The MSCC coordinator's responsibilities and the support they should receive are described in NICE clinical guideline 75 recommendations 1.1.2.3 and 1.1.2.5.

The Manual for cancer services: acute oncology – including metastatic spinal cord compression measures (2011; measure 11‑3Y‑304) lists the criteria that the MSCC coordinator service should fulfil.

Symptoms and signs of MSCC

The following symptoms and signs are suggestive of MSCC:

  • progressive pain in the spine

  • severe unremitting spinal pain

  • spinal pain aggravated by straining (for example, at stool, when coughing or sneezing, or when moving)

  • pain described as 'band like'

  • localised spinal tenderness

  • nocturnal spinal pain preventing sleep

  • neurological symptoms: radicular pain, any limb weakness, difficulty in walking, sensory loss, or bladder or bowel dysfunction

  • neurological signs of spinal cord or cauda equina compression.

[Definition developed from NICE clinical guideline 75 recommendations 1.3.2.1 and 1.3.2.2 and expert consensus]