Quality standard

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

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

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.

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: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.

What the quality statement means for different audiences

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.

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

Source guidance

Spinal metastases and metastatic spinal cord compression. NICE guideline NG234 (2023), recommendations 1.1.15, 1.1.16 and 1.3.4

Definitions of terms used in this quality statement

MSCC coordinator

The MSCC coordinator ensures that:

  • key information about each person is recorded; this includes information on:

    • clinical presentation

    • neurological assessment

    • performance status

    • frailty assessment

    • investigations, including imaging reports

    • oncology assessment and disease staging

    • individual needs, preferences and circumstances (for example, language and communication needs)

  • initial triage of information about the person's care is performed

  • appropriate information is shared with primary care and with the multidisciplinary team

  • discharge planning is coordinated.

They provide initial advice to referring healthcare professionals on:

  • pain management

  • spinal stability

  • immobilisation

  • the use of dexamethasone

  • referral and transfer for specialist treatment.

An MSCC coordinator should be available 24 hours a day, 7 days a week, acting as a single point of contact for healthcare professionals. [Adapted from NICE's guideline on spinal metastases and metastatic spinal cord compression, recommendations 1.1.7, 1.1.15 and 1.1.16]

Symptoms and signs suggestive of MSCC

The following pain characteristics are suggestive of spinal metastases:

  • severe unremitting back pain

  • progressive back pain

  • mechanical pain (aggravated by standing, sitting or moving)

  • back pain aggravated by straining (for example, coughing, sneezing or bowel movements)

  • night-time back pain disturbing sleep

  • localised tenderness

  • claudication (muscle pain or cramping in the legs when walking or exercising).

The following pain characteristics are suggestive of cord compression:

  • bladder or bowel dysfunction

  • gait disturbance or difficulty walking

  • limb weakness

  • neurological signs of spinal cord or cauda equina compression

  • numbness, paraesthesia or sensory loss

  • radicular pain.

[Adapted from NICE's guideline on spinal metastases and metastatic spinal cord compression, box 1]