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--- proc:out_of_hours_mri [2024/07/12 10:46] – typo admin
+++ proc:out_of_hours_mri [2024/09/10 14:51] (current) – [Plymouth] a.wijnberg
@@ Line 1: / Line 1: @@
 ====== Out of Hours MRI ======
-Out of hours MRI is largely reserved for MRI ? CES, and is very variable between sites, with Plymouth and Truro offering overnight scanning, and Truro and Torbay having more limited service. Detailed site by site guides below:
+Out of hours MRI is largely reserved for MRI ? CES, and is very variable between sites, with Plymouth and Exeter offering overnight scanning, and Truro and Torbay having more limited service. Detailed site by site guides below:
 ===== Plymouth =====
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 Where PROC wants to reject a scan, or where the is any doubt about the justification or timing of a scan, contact the on-call neuroradiology consultant.
-There are a couple of areas where the current guidance causes a bit of uncertainty - namely where there is isolated bilateral sciatica, and where symptoms have been stable for > 2 weeks. As per GIRFT guidance these patients do not meet criteria for emergent imaging and there has been communication from Plymouth Neuroradiology to this effect, but a out of hours scan for these patients "is indicated" as per the local guidance document. A reasonable approach would be to suggest to the clinical team that the scan can wait for the morning in these situations, and escalate to the on-call neuroradiology consultant if the clinical team insist.
+There are a couple of areas where the current guidance causes a bit of uncertainty - namely where there is isolated bilateral sciatica, and where symptoms have been stable for > 2 weeks. As per GIRFT guidance these patients do not meet criteria for emergent imaging and there has been communication from Plymouth Neuroradiology to this effect, but strictly a out of hours scan for these patients "is indicated" as per the local guidance document. A reasonable approach would be to suggest to the clinical team that the scan can wait for the morning in these situations, and escalate to the on-call neuroradiology consultant if the clinical team insist.
 ==== Other Presentations ====
-All other neurological presentations where a MRI is requested to be performed overnight need to be discussed with the neuroradiology consultant on call. Check with the clinical team that it is required for overnight, and is going to impact management overnight. Note that radiotherapy is not available overnight, so ? metastatic cord compression imaging is not felt indicated overnight.
+All other neurological presentations where a MRI is requested to be performed overnight need to be discussed with the neuroradiology consultant on call. Check with the clinical team that it is required for overnight, and is going to impact management overnight. Ideally the patient should have been seen by the Neurosurgical team, and you are encouraged to inform the clinicians that the request should be from the Neurosurgical consultant to the on-call Neuroradiologist. Note that radiotherapy is not available overnight, so ? metastatic cord compression imaging is not felt indicated overnight.
 ==== Arranging Imaging ====
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 [[https://nhs.sharepoint.com/:w:/r/sites/msteams_e1797f/Shared%20Documents/General/PROCuments/UHP/MRI%20OOH%20Neuro%20PROC%20guidelines%20(Final).docx?d=w04ee79e3eab94a53b87619fbc3bcdb50&csf=1&web=1&e=qd9y42|Derriford Out of Hours MRI Guidance]]
+++++
+===== Truro =====
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+An on-call MRI service is available to scan suspected CES only between 2000-2200, but Truro does not offer MRI for any indication from 2200 - 0730. If a patient is thought to absolutely require MRI overnight, the patient must be transferred to Derriford and have the scan in Derriford. Dedicated slots exist in the morning in Truro for urgent ? CES scans that can wait.
+To arrange a scan from 2000-2200 confirm the patient has no contra-indications to MRI, vet the MRI on CRIS [[proc:ct_vetting|as per CT vetting]], and then contact the MRI team via switchboard. For scans for the morning just check contra-indications then vet. Ambulatory patients should be told to attend MRI for 0730, and ED should be told to contact the MRI at 0730 for non-ambulatory patients.
+[[https://nhs.sharepoint.com/:w:/r/sites/msteams_e1797f/Shared%20Documents/General/PROCuments/Truro/Emergency%20MRI%20at%20RCHT.%20PROC%202019.docx?d=wd21c281695104b95858530a828eeed27&csf=1&web=1&e=Iw4j8g|Truro Out-of-Hours MRI SOP]]
 ++++
 ===== Exeter =====
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 ++++
+===== Torbay =====
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+Out of hours MRI in Torbay is only offered for suspected CES, and is not available 24 hours a day.
+Referrals made prior to 2200 that are accepted but the PROC registrar should have vetting completed and MRI contra-indications checked, and then promptly called through to the MRI radiographer on-call via switchboard.
+Referrals accepted after 2200 will be scanned the following day at 0800 - in order to arrange this, the scan should be vetted, then the referrer should be instructed to complete the safety questionnaire and called the MRI answer phone on 01803 655654. The referrer should arrange for the patient to come to MRI for 0800 the following morning, but cannot be left unattended in the MRI department.
+[[https://nhs.sharepoint.com/:w:/r/sites/msteams_e1797f/Shared%20Documents/General/PROCuments/Torbay/Torbay%20overnight%20MRI%20process%20for%20PROC.docx?d=wa7ef2b2717bf44ae981f90a56d05d309&csf=1&web=1&e=r7Zvzd|Out of hours MRI for corda equina at Torbay]]
+[[https://nhs.sharepoint.com/:w:/r/sites/msteams_e1797f/Shared%20Documents/General/PROCuments/Torbay/Torbay%20overnight%20MRI%20process%20for%20PROC.docx?d=wa7ef2b2717bf44ae981f90a56d05d309&csf=1&web=1&e=6U3eXF|Summary of Torbay overnight MRI process for PROC]]
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+===== Barnstaple =====
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+Barnstaple does not offer out of hours MRI.
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+===== Useful Links =====
+[[https://gettingitrightfirsttime.co.uk/wp-content/uploads/2023/10/National-Suspected-Cauda-Equina-Pathway-October-2023-version-3.drawio.html|GIRFT Guidance on Suspected Acute CES]]